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APPLICATION FOR EMPLOYMENT

Do you have a resume? If YES, complete and return pages 1-2 of this packet with your resume.


If NO, complete and return this entire packet.

Thank you for your interest in employment with GSA!

Today's Date
Month
Day
Year
Position Applied For
Position 1
Position 2
Position 3
Position 4
Position 5
Position 6
Available Start Date
Month
Day
Year
Multi-line address
Interested In:
Full Time
Part Time
Full or Part Time
Days/Hours Available to Work:
Month
Day
Year
Time
HoursMinutes
Days/Hours Available to Work:
Can you work nights/weekends (for on-call positions)?
Yes
No
Are you willing/able to travel overnight as needed?
Yes
No
Do you have a driver’s license?
Yes
No

Military Experience

Have you ever been in the Armed Forces?
Yes
No
Are you a current member of theNational Guard?
Yes
No

References

Please list three (3) references other than relatives or previous employers.

Reference 1

Reference 2

Reference 3

Applicant Agreement and Acknowledgment


In consideration of my application for employment with Gulf States Automation (“the Company”), I acknowledge and agree to the following:

Employment Relationship

  • The acceptance of my application, or any future employment in the position applied for or any other role, does not create an actual or implied contract of employment.

  • Regardless of any employee handbooks, personnel manuals, benefit plans, policies, or Company practices that may exist from time to time, no such materials shall alter the employment-at-will relationship.

  • Employment with the Company is strictly “at-will,” meaning that either I or the Company may terminate the employment relationship at any time, with or without notice or reason.

  • This relationship may only be altered by a written agreement signed by the President/General Manager of the Company.

  • I understand the Company reserves the right to change, modify, or reduce its benefits, policies, or procedures at any time.

  • Adherence to Mission and Core Values

  • I understand that as an employee of Gulf States Automation, I am expected to uphold and adhere to the Company’s mission statement and core values.

  • These principles guide how the Company serves its customers, works with team members, and represents itself in the community.

  • I agree to conduct myself in a manner consistent with these values and to support the mission of the Company in the performance of my duties.

    Authorization for Verification

  • I authorize the Company to investigate all statements made in this application.

  • I understand that any misrepresentation or omission of requested information may result in immediate dismissal, without prior notice.

  • I authorize the Company to contact schools, previous employers (unless otherwise noted), references, and

  • other appropriate sources, and I release the Company from any liability resulting from such inquiries.


Drug, Alcohol, and Physical Examinations


  • I understand the Company maintains a drug and alcohol policy that includes pre-employment and post-employment testing.

  • Compliance with this policy is a condition of employment.

  • Continued employment may be contingent upon passing job-related physical examinations as required.


    Consumer Reports

  • I understand that as part of the routine processing of my application, the Company may request an investigative consumer report from a consumer reporting agency.

  • This report may include information regarding my credit history, character, reputation, personal characteristics, and lifestyle.

  • Upon my written request, the Company will provide additional details regarding the nature and scope of such reports, as required by the Fair Credit Reporting Act.


    Probationary Period

  • I understand that if hired, my employment will be subject to a probationary period of sixty (60) days.

  • During or after this probationary period, either the Company or I may terminate employment at any time.

Signature Date
Month
Day
Year
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Work Experience

List your experience for the past five years, beginning with your most recent job.

Work Experience 1

Work Exp 1 Address
Work Exp 1 Start Date
Month
Day
Year
Work Exp 1 Completion Date
Month
Day
Year

Work Experience 2

Work Exp 2 Address
Work Exp 2 Start Date
Month
Day
Year
Work Exp 2 Completion Date
Month
Day
Year

Education

Provide information about your educational background.

Education High School Address
High School Number of Years Completed:
1 year
2 years
3 years
4 years
Business/Trade School address
Business/Trade Number of Years Completed:
1 year
2 years
3 years
4 years
College address
College Number of Years Completed:
1 year
2 years
3 years
4 years
5 years
6 years
Education Other address

Additional Information

An application or résumé may not fully capture your background and experience. Please use the space below to provide any additional information that highlights your qualifications for the specific position you are applying for.

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