Careers

Application



First Name *
Last Name *


Address *
City *
State *
v
Zip Code *
Email
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
v

Are you currently employed?
If so, may we contact your present employer?
Have you ever applied to this company before?


Education History



High School


School Name
Years Attended
Did you graduate?


College


School Name
Years Attended
Subjects Studied
Did you graduate?


Trade School


School Name
Years Attended
Subjects Studied
Did you graduate?


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


US Military or Naval Service?
Rank


Former Employers

Start with most recent


Employer 1


Employer
Position
Salary

Address
City
State
v
Zip Code

Start Date
v
End Date
v
Reason for leaving


Employer 2


Employer
Position
Salary

Address
City
State
v
Zip Code

Start Date
v
End Date
v
Reason for leaving




References



Reference 1


Name
Business

Address
City
State
v
Zip Code
Phone:
Years Known


Reference 2


Name
Business

Address
City
State
v
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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