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Gas Field Specialists, Inc. – Employment Application
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Employment Application

Gas Field Specialists, Inc.  |  Document #: HR-00000-040  |  Rev. 0003

Shinglehouse, PA2107 SR 44 South
Shinglehouse, PA 16748
gfs.hr@gfsinc.net
Horseheads, NY22 E St., Building 17-2
Horseheads, NY 14845
gfs.hr@gfsinc.net
Mansfield, PA114 Route 660
Mansfield, PA 16933
gfs.hr@gfsinc.net
Smithton, PA182 Painter Rd.
Smithton, PA 15479
gfs.hr@gfsinc.net
Please fill out the information below as completely and accurately as possible. Failure to do so could result in rejection of application.
To Be Read and Signed by Applicant

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

"I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.21(d) and (e). I understand that I have the right to:

  • Review information provided by current/previous employers;
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information."
Current Address
Past 3-Year Residency — Address 1 (if different)
Past 3-Year Residency — Address 2 (if applicable)
A. Position Details
Position Location (select all that apply)
Referred By
Availability (select all that apply)
B. Education
Type Name & Location of School Dates Attended / Year Graduated Graduate? Area of Study & Degree Acquired
High School
College
Vocation / Trade School
(Welder, Operator, CDL Driver)
Employment History
Note: CDL holders must provide all employer information for the preceding 10 years. All others: 3 years required. You are required to list the complete mailing address: street number and name, city, state and zip code.
Current / Last Employer
Were you subject to Federal Motor Carrier Safety Regulations while employed?
Was your job designated as a safety-sensitive function subject to 49 CFR Part 40?
Second Last Employer
Federal Motor Carrier Safety Regulations?
Safety-sensitive / DOT 49 CFR Part 40?
Third Last Employer
Federal Motor Carrier Safety Regulations?
Safety-sensitive / DOT 49 CFR Part 40?
Driving Experience
Class of EquipmentType of EquipmentFromToApprox. Miles
Straight Truck
Tractor & Semi-Trailer
Tractor – Two Trailers
Tractor – Three Trailers
Motorcoach – School Bus (>8 passengers)N/A
Motorcoach – School Bus (>15 passengers)N/A
Other:
Accident History (3 Years)
Date (MM/YYYY)Nature of AccidentFatalitiesInjuriesHazmat Spill?
Traffic Convictions & Forfeitures (3 Years)
Date Convicted (MM/YYYY)ViolationStatePenalty
License Information

Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
B. Has any license, permit, or privilege ever been suspended or revoked?
Document Uploads
Accepted formats: PDF, DOC, DOCX, TXT
Accepted formats: PDF, DOC, DOCX, TXT
Certification & Acknowledgements

Please read each statement closely and initial each on the line next to the title, acknowledging your understanding. If clarification is needed, please contact Human Resources.

Equal Employment Opportunity Statement

This Company is committed to the principles of equal employment opportunity and is committed to make employment decisions based on merit. We are committed to complying with all Federal, State and local laws providing for equal employment opportunities, as well as all laws related to terms and conditions of employment. The Company desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate those physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the Company.

Complete and Accurate Information

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of material fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

At-Will Employment

I understand and agree that if I am employed, my employment will be "at-will", which means that the Company may terminate the employment relationship at any time, with or without cause and with or without notice. Likewise, the Company will respect my right to terminate my employment at any time, with or without cause and with or without notice. I further understand that any prior representation, whether expressed or implied to the contrary is hereby superseded and that no promise or representation contrary to the foregoing is binding on the Company unless made in writing and signed by the Company's president.

Post-Hire, Pre-Employment Testing

If offered a position with the Company, I understand that I may be asked to undergo legally permitted physical, psychological, skill, drug or medical test required by the Company as a condition of employment.

GAS FIELD SPECIALISTS, INC. IS SUBJECT TO FEDERAL REGULATIONS, INCLUDING DOT REGULATION 49 CFR PART 40 AND PART 199 COVERING PRE-EMPLOYMENT DRUG TESTING AND ONGOING RANDOM AND REASONABLE SUSPICION DRUG TESTING DURING EMPLOYMENT. GAS FIELD SPECIALISTS, INC. WILL BE UNABLE TO HIRE APPLICANTS WHOSE DRUG TEST IS RETURNED 'POSITIVE', REGARDLESS OF THE LEGALITY AND USE OF SUCH DRUGS AT THE STATE LEVEL.

Background Investigation

I acknowledge that if I am offered employment with the Company, a job offer may also be contingent upon a background investigation which may include interviews with past employers, workers, and friends. Said investigation may include credit, driving, criminal background, references and other background checks.

Financial Obligation

I understand and agree that, if I become indebted to the Company, I will be responsible for repaying the total owed upon termination from the Company. If I do not repay the sum prior to receipt of my final paycheck, the money owed will be deducted from my pay.

Company Obligation

I understand and agree that the Company's acceptance of this job application does not mean that a position for which I am qualified is open (unless specifically posted) or that the Company has agreed to hire me. I understand that the Company is under no obligation to hire me as the result of accepting this completed application.

Applicant Certification

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

✓ Your application has been submitted! Your email client will open with the completed application addressed to gfs.hr@gfsinc.net. Please attach your resume and cover letter if prompted, then send.

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