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5680 US HWY 64

Farmington, NM 87401

(505)327-2222

PLEASE READ THIS BEFORE FILLING OUT THE APPLICATION FORM

Applications on file will be kept for a minimum of 3 Months.

All full-time employees must be 18 years of age or older to be considered for employment.

Part-time and summer employees that are 16 years of age, must provide documentation from their school system for eligibility of right to work.

All positions are subject to a post job offer drug screening and physical.

Any position that requires the use of a company vehicle are subject to having a motor vehicle report pulled and upon hiring the report will be monitored monthly.

PESCO is an equal opportunity employer and does not discriminate on the basis of religion, color, national origin, age, sex, gender, disability or any other characteristic protected by law. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Applicant requiring reasonable accommodations in the application and/or interview process should notify a representative of the organization.

Thank you for your interest in PESCO.

Personal
Position or Positions Desired*
- Welder
- Code Welder
- Pipefitter
- Layout Tech (fabricator)
- Warehouse / Materials
- Maintenance
- Clerical / Accounting
- Field Service
- Electrical
- Forklift
- Safety
- Information Technology
- Human Resources
- Engineering
- Drafting / Design
- Administration / Management
- Purchasing
Name*
First Middle Last
Physical Address*
Street Address Address Line 2 City State ZIP Code
Phone*
I authorize PESCO to contact me via text message for scheduling and updates?*
- Yes
- No
Secondary Phone
Email
Enter Email Confirm Email
Are you eligible to be employed in this country?*
- Yes
- No
(Verification of employment status will be required on hire.)
Are you a Veteran?*
- Veteran
- No
If the position you are applying for requires you to operate a company vehicle, can you provide documents to establish ability to operate a vehicle?*
- Yes
- No
(Valid state issued driver's license.)
Have you ever been employeed by PESCO?*
- Yes
- No
If yes, when and what department?*
Education
High School Diploma or GED?*
- Yes
- No
Name and Location (City & State) of High School Attended?*
Higher Education
College or Program Degree or Certificate Earned Major/Field of Study

Click the + to add more lines.
Military Experience
Branch of Service Dates

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Attachments
Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 256 MB, Max. files: 3.
Please include any resume or cover letter if availble. Please upload a PDF or Word Document.
Employment
List Your Employment History Starting With Your Most Recent Job.*
Employer Name and Phone Duties Pay Rate Start Date End Date Reason for Leaving

Click the + to add more lines.
List any Other Trainings, Certifications, Job Skills, Etc.
References
List Three Persons Who You Are Not Related To and Who Have Knowledge Of Your Qualifications, Work History and Experience.*
Name Phone Number Company Relationship

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Were you referred by a PESCO Employee? If so list that employee here.
Field Service, Safety, Maintenance
State and Federal privacy laws protect and prescribe restrictions regarding access to certain confidential and personal information. This form authorizes the release of motor vehicle and personal information to PESCO for employment or insurance eligibility purposes.
Driving positions may require a minimum age of 21 years and age requirements are subject to change with insurance providers.

Field Service positions are subject to a pre-employment drug screening and a DOT physical.

Field Service positions require the use of a company vehicle and are subjst to having a motor vehicle report pulled upon hiring, the report will be monitored monthly.
Name as it Appears On Drivers License*
First Middle Last
Birth Date*
MM slash DD slash YYYY
Drivers License*
State License # Type Expiration
Have you ever been denied a license, permit or priviledge to operate a motor vehicle?*
- Yes
- No
If yes, explain*
Has any license, permit or privilege ever been suspended or revoked?*
- Yes
- No
If yes, explain*
Traffic Convictions and Forfeitures for the Past 3 Years
Date Convicted Violation State of Violation Penalty

Do not include parking violations. Click the + to add more lines.
Accident Record for the Past 3 Years
Date Nature of Accident Injuries (Yes or No) Chemical Spills (Yes or No)

Click the + to add more lines.
I authorize PESCO to investigate and review driving, motor vehicle, criminal histories and related information periodically the duration of my employment or insurance relationship with PESCO.*
- I agree
DISCLOSURE STATEMENT _Process Equipment and Service Company_ (the Organization). when considering your application for employment, insurance or credit, when making a decision whether to offer you employment, insurance or credit, when deciding whether to continue your employment, insurance or credit. and when making other decisions directly affecting you. may wish to obtain and use a "consumer report" from a "consumer reporting agency". These terms are defined in the FCRA (I 5 US.C. SS 1861 et seq.). which applies to you. You are a "consumer" with rights under the FCRA. A "consumer" is an individual. A "consumer reporting agency" is any person or business which for monetary fees. dues. or on cooperative nonprofit basis. regularly engages in whole or in part in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing "consumer reports" to others. and which uses any means or facility of interstate commerce for the purpose of preparing or furnishing "consumer reports". A "consumer report" is any written, oral, or other communication of any information by a "consumer reporting agency" bearing on a consumer's credit worthiness, credit standing. credit capacity. character, general reputation. personal characteristics, or mode of living which is used or expected to be used or collected. in whole or in part. for the purpose of serving as a factor in establishing the consumer's eligibility for employment purposes or other purposes authorized under the FCRA. If the Organization obtains a "consumer report" about you, and if. based on any information in the consumer report, the Organization makes a decision for employment, insurance or credit purposes that directly and adversely affects you, you may be provided with a copy of the "consumer report". You may also contact the Federal Trade Commission about your rights under the FCRA as a "consumer" with regard to "consumer reports" and "consumer reporting agencies". The Organization has contracted with SAMBA Holdings. Inc. to provide records. SAMBA furnishes information as avai lable from state and national agencies. SAMBA does not issue an opinion on the information provided. or participate in any action or decision based on the information provided. SAMBA may be contacted in writing concerning a consumer report about you: In writing: SAMBA Holdings. Inc. 1730 Montano NW Suite F Albuquerque, NM 87107 By phone: 1-800-947-2622 2005 1208 Release and Disclosure Fonn
I understand that my employment or insurance eligibility is contingent upon PESCO's review of such information; and I confirm that i have read and understand the attached Disclosure Statement.*
- I agree
Certification and Agreement
I hearby declare the information I have provided in this Application for Employment is true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement may be considered grounds for dismissal. I authorize investigation of all statements made on this application. I hearby replease PESCO, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested informtion and release them from all liability for providing the requested information.*
- I agree
Signature*

Please print your full name.
Comments
This field is for validation purposes and should be left unchanged.

College or Program	Degree or Certificate Earned	Major/Field of Study

Employer Name and Phone	Duties	Pay Rate	Start Date	End Date	Reason for Leaving

Date	Nature of Accident	Injuries (Yes or No)	Chemical Spills (Yes or No)

Branch of Service	Dates

Name	Phone Number	Company	Relationship

Date Convicted	Violation	State of Violation	Penalty

Personal

Education

Employment

References

Field Service, Safety, Maintenance

Certification and Agreement