Careers

Application

First Name *

Last Name *

Address *

City *

State *

Zip Code *

Phone *

I, the undersigned, hereby authorize R & R Pipeline, Inc. or its insurance agency, Kernan Insurance Agency, Inc., or its assigns, to obtain copies of a motor vehicle report pertaining to me for employment purposes and for use in rating and/or underwriting insurance for which the above-named employer may apply, and any renewal thereof.

Last 4 digits of SSN *

Drivers License # *

Date of Birth *

Position Desired

Salary Desired

Date Available to Start

Are you currently employed?

Yes

If so, may we contact your present employer?

Yes

Have you ever applied to this company before?

Yes

Education History

High School

School Name

Years Attended

Did you graduate?

Yes

College

School Name

Years Attended

Subjects Studied

Did you graduate?

Yes

Trade School

School Name

Years Attended

Subjects Studied

Did you graduate?

Yes

Please list any special skills, subjects of study, research or work training.

US Military or Naval Service?

Yes

Rank

Former Employers

Start with most recent

Employer 1

Employer

Position

Salary

Address

City

State

Zip Code

Start Date

End Date

Reason for leaving

Employer 2

Employer

Position

Salary

Address

City

State

Zip Code

Start Date

End Date

Reason for leaving

References

Reference 1

Name

Business

Address

City

State

Zip Code

Phone:

Years Known

Reference 2

Name

Business

Address

City

State

Zip Code

Phone:

Years Known

Authorization

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

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R & R PIPELINE, INC

155 Dayton Road
Newark, Ohio 43055

Phone: 740-345-3692
Fax: 740-349-1987
Hours: M-F 8am to 5pm

Careers

Application

Education History

High School

College

Trade School

Former Employers

Employer 1

Employer 2

References

Reference 1

Reference 2

Authorization

Safety

Quality

Services

R & R PIPELINE, INC

OUR COMPANY

SERVICES

RESOURCES