Houston Controls

Application

1. Personal History

   Name:	List other names you have used if needed for verification of employment or education record.
   Email Address:	Cell Phone:
   Address:	Home Phone:
   City:	Work Phone:
   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Zip Code:	Social Security No. (no dashes)

2. Education

   1. High School

      Name of High School or GED Issuer	City	State	Did you Graduate?
      			NoYes
      			NoYes

      Highest grade completed: 123456789101112
      

   2. College or University

      Name of College and Location	Subject Major  Minor	Number of Years Attended	Degree Received
      		0123456789101112131415+
      		0123456789101112131415+
      		0123456789101112131415+

   3. Other Training

      Name and Address of School	Study or Specialization	Starting Date	Ending Date

3. Employment History

   List last 10 years of employment history starting with your present or most recent position. Include all relevant paid, non-paid, volunteer, and military experience. List promotions as separate jobs. Resume CANNOT substitute for completion of this page.

   May we contact your current employer? NoYes

   Name and Address of Employer	Dates Employed From Month/Yr To Month/Yr	Salary/Earnings Starting: $ Ending:  $
   Exact title of your position:	Name of Immediate Supervisor: Phone:	Reason for Leaving:
   Description of work:

   Name and Address of Employer	Dates Employed From Month/Yr To Month/Yr	Salary/Earnings Starting: $ Ending:  $
   Exact title of your position:	Name of Immediate Supervisor: Phone:	Reason for Leaving:
   Description of work:

   Name and Address of Employer	Dates Employed From Month/Yr To Month/Yr	Salary/Earnings Starting: $ Ending:  $
   Exact title of your position:	Name of Immediate Supervisor: Phone:	Reason for Leaving:
   Description of work:

4. Military Record

   Have you ever served on active duty in the armed forces of the United States? NoYes

   Type of discharge:

   Dates of Active Duty:
   From To

   Are you a member of the Reserve? NoYes   -Select-InactiveActive

5. Court Record

   Have you ever been convicted of a crime? NoYes   If yes, list all such matters regardless of disposition.

   Conviction will not necessarily disqualify an applicant from employment.

   Date	Place and Department	Charge	Disposition	Details

6. Membership in Organizations

   Are you or have you been a member in professional organizations related to the position applied for? NoYes

   Name	City and State	Former Member	Present Member	If present, list position and extent of activity
   		NoYes	NoYes
   		NoYes	NoYes
   		NoYes	NoYes

7. Relatives

   Do you have any friends and/or relatives employed by Houston Controls? NoYes
   If yes, list names, relationship, position and department

   Name	Relationship	Position	Department

8. Physical Data

   Having read the job description, are you able to perform all essential elements of the position?NoYes
   If no, please explain below.

9. Skills

   Complete only if related to the position applied for.

   1. Do you have a valid driver's license? NoYes  State of Issue: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
   2. Do you have a Master Electrician's license? NoYes License Number
   3. Do you have a Journeyman Electrician's license? NoYes License Number
   4. Do you have a Apprentice Electrician's license? NoYes License Number
   5. Do you have NCCER certification? NoYes    Craft   
      License Number
   6. Do you have TWIC certification   NoYes    Expiration
   7. Do you have expertise in the following areas? Select years of experience.

      Process Controls	0123456789101112131415+	Electrical Controls	0123456789101112131415+
      Commissioning/Start-up	0123456789101112131415+	Electrical Line Work	0123456789101112131415+
      Live Cut-Over	0123456789101112131415+	138-kV Oil & Gas CBB, Air Switches	0123456789101112131415+
      DCS	0123456789101112131415+	15-kV Switchgear, Vacuum & Air Magnetic CB, Air Switches	0123456789101112131415+
      PLC	0123456789101112131415+
      Relay Logic	0123456789101112131415+	5-kV Switchgear, Vaccum & Air MagneticCB, Air Switches, MCC	0123456789101112131415+
      Instrument Troubleshooting	0123456789101112131415+
      Instrument PM	0123456789101112131415+	480-V Switchgear, Power CB, MCC	0123456789101112131415+
      Control Valves	0123456789101112131415+	UPS & Backup Generators	0123456789101112131415+
      Reading P&ID's	0123456789101112131415+	Electrical Troubleshooting	0123456789101112131415+
      Reading Instrument Installation Details	0123456789101112131415+	Reading One-Line & Motor Schematics	0123456789101112131415+
      Reading Loop Diagrams	0123456789101112131415+	National Electric Code	0123456789101112131415+
      Panel Shop Fabrication	0123456789101112131415+	EMT Conduit Installation	0123456789101112131415+
      Sample Panel Fabrication	0123456789101112131415+	Rigid Conduit Installation	0123456789101112131415+
      High Press Heavy Wall Tubing Applications	0123456789101112131415+	PVC Coated Conduit Installation	0123456789101112131415+
      Group Tubing Runs	0123456789101112131415+	Underground Conduit Installation	0123456789101112131415+
      Group Tube Bundle Runs	0123456789101112131415+	Cable Tray Installation	0123456789101112131415+
      Analyzer Tube Bundle	0123456789101112131415+	Grounding Installation	0123456789101112131415+
      Process Tubing Bundle	0123456789101112131415+	Multi-Conductor & Armored Cable Pulls	0123456789101112131415+
      Steam Tracing	0123456789101112131415+	Medium Voltage Termination (Stress Cones)	0123456789101112131415+
      Electric Tracing	0123456789101112131415+	Power Terminations	0123456789101112131415+
      Tubing Tray	0123456789101112131415+	Controls Terminations	0123456789101112131415+
      Screw Pipe	0123456789101112131415+	Using Cadweld Equipment	0123456789101112131415+
      Metal Fabrication (Stands, Supports, Etc.)	0123456789101112131415+	Commercial Installation	0123456789101112131415+
      Installing Instruments and Stands	0123456789101112131415+	Residential Installation	0123456789101112131415+
      Structural Welding	0123456789101112131415+

   8. Do you have Certifications in the following areas?

      Bucket Truck	NoYes	Forklift	NoYes
      JLG Lift	NoYes	Back Hoe	NoYes
      Scissor Lift	NoYes	Pole Truck	NoYes
      Cherry Picker	NoYes	LOTO	NoYes
      Safety	NoYes	CPR	NoYes
      Instructor	NoYes	OSHA	NoYes

   List any special qualifications, skills, or licenses you hold relevant to the position for which you are applying which are not covered elsewhere in this application, to include office equipment, construction equipment and language skills.

10. Other References

    Other references not listed in employment history.

    Years Known	Complete Name (Last, First, Middle)	Indicate Business or Home Address	Telephone Number	Business or Occupation
    0123456789101112131415+
    0123456789101112131415+
    0123456789101112131415+

11. Prior Employment with Houston Controls

    
    
    • Have you ever applied for employment with Houston Controls? NoYes
    • If yes, what position(s)?   When?
    • Have you ever been employed by Houston Controls? NoYes
    • If yes, what position(s)?
    • Dates of prior employment: to
    • Reason for leaving
      

12. Personal Declarations

    1. Within the last five years, have you been fired for any reason? NoYes
       If yes, please explain:
    2. Within the last five years, have you quit a job after being notified that you would be fired? NoYes
       If yes, please explain:
    3. Are you willing to work overtime? NoYes
    4. Are you willing to travel? NoYes Outside of the US? NoYes

1. UNDER THE IMMIGRATION CONTROL ACT OF 1986, AN EMPLOYER IS REQUIRED TO HIRE ONLY U.S. CITIZENS AND LAWFULLY AUTHORIZED ALIEN WORKERS. APPLICANTS WHO ARE SELECTED FOR EMPLOYMENT WILL BE REQUIRED TO SHOW AND VERIFY AUTHORIZATION TO WORK IN THE UNITED STATES, WITHIN THREE (3) DAYS OF BEGINNING WORK.
2. I understand that I may be required to submit to such job related examinations as may be required. I also understand that I must submit to a physical examination in which includes a drug screening.
3. Acceptance of this application is not intended to create or imply a contractual relationship. If hired, I understand I will be required to serve a probationary period during which time my job performance and conduct will be evaluated, and that my employment may be terminated if either performance or conduct is unsatisfactory. I also understand that all benefits of employment are subject to change by Houston Controls Management with or without notice.
4. I authorize investigation of all statements contained in this application for employment. I understand that any false or incomplete answer may be grounds for not employing me or for dismissing me after I begin work.
5. I certify that every answer and statement that I have made in this application is true and complete to the best of my knowledge.

Houston Controls considers applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, non-disqualifying physical or mental handicap, personal appearance, political opinion, sexual orientation, labor organization affiliation, or any other legally protected status.

I have read and agree to the declarations listed above.

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