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If you wish to apply for a position at Pioneer Contract Services, Inc. please fill out the form below to the best of your ability and knowledge, and submit it for review.

Prospective employees will receive consideration without discrimination because of race, religion, color, sex, age, national origin, disability, veteran status or any other status protected by law.

Files are purged after 90 days.

If you would prefer to fill out and print a hard copy of your application to send to our office, download the PDF file. This file contains entry fields for completing the application.

 PioneerEmpApp_08-01.pdf
[1.6 MB]

Application for Employment* Required Fields

Date: mm/dd/yy *Email:
Personal Information
*Name Last
 First
 Middle
 Social
Security #		xxx-xx-xxxx
Address Number & Street or PO Box
 City
 State
 Zip
Phone Home (xxx-xxx-xxxx)
 Work or Business (xxx-xxx-xxxx)
Have you ever applied for employment with Pioneer? Yes No
Have you previously been employed by Pioneer? Yes No Month/Year
Position Desired Pay Expected
Referred by
Apart from absence for religious observance, are you available for full-time work? Yes No
Will you work overtime if asked? Yes No
Are you legally eligible for employment in the United States? Yes No
Explanation
When will you be available to begin work?dd/mm/yy
Education
SchoolName and Location of SchoolNo. of
Years
Completed		Did You
Graduate?		Degree or
Diploma		Course
of Study
GraduateYes No
CollegeYes No
Business
Trade
Technical		Yes No
High
School		Yes No
Specific Skills
Other special training or skills (languages, machine operation, etc.)
Employment
Please give accurate, complete full-time and part-time employment record. Start with your most recent employer.
1
Company Name
 Name of Supervisor
 Phonexxx-xxx-xxxx
Address Number & Street or PO Box
 City
 State
 Zip
Job Title and Description of Work
Employed From month - year
 To month - year
 Weekly Pay Start
 Last
Reason for Leaving
2
Company Name
 Name of Supervisor
 Phonexxx-xxx-xxxx
Address Number & Street or PO Box
 City
 State
 Zip
Job Title and Description of Work
Employed From month - year
 To month - year
 Weekly Pay Start
 Last
Reason for Leaving
3
Company Name
 Name of Supervisor
 Phonexxx-xxx-xxxx
Address Number & Street or PO Box
 City
 State
 Zip
Job Title and Description of Work
Employed From month - year
 To month - year
 Weekly Pay Start
 Last
Reason for Leaving
4
Company Name
 Name of Supervisor
 Phonexxx-xxx-xxxx
Address Number & Street or PO Box
 City
 State
 Zip
Job Title and Description of Work
Employed From month - year
 To month - year
 Weekly Pay Start
 Last
Reason for Leaving

Do Not Contact

We may contact the employers listed above unless you indicate those you do not want us to contact.

Do not contact Employer Number(s) 1 2 3 4

Reason
Military
Did you serve in the U.S. Armed Forces? Yes No
If "Yes," in what Branch?
Date Entereddd/mm/yy
 Date Dischargeddd/mm/yy
Rank

Note: If you do not desire to be identified as a disabled and/or Vietnam Era Veteran, you need not complete the following questions.

Are you a Disabled Veteran? Yes NoAre you a Vietnam Era Veteran? Yes No
Describe any training received relevant to the position for whcih you are applying.
Personal References
 NameAddressPhoneYears
Acquainted
1
2
3
Truck Drivers Only
Do you have a commercial driver's license? Yes No
Drivers License No. State
 Type
 Endorsements
How long have you driven a truck? Years Months
Have you had any automobile violations/accidents? Yes No If "Yes," describe below:
 DateLocationDetails
1
2
For insured drivers of company vehicles, are you at least 25 years of age? Yes No
History
Have you been convicted, pled guilty, pled no contest,
or been sentenced to deferred adjudication for a felony offense? Yes No
If "Yes," describe in full.
Approve & Submit

If applying for Supervisor, Mover, Panel Technician and/or Driver, these positions require lifting of heavy objects.

All new hires are required to undergo any appropriate medical examinations, and will be required to abide by the company's drug-alcohol free workplace policy as a condition of employment.

I agree to take a defensive driving course and to attend safety meetings on my own time without pay that the company may require during the course of my employment.

The information provided in this Application for Employment is true, correct, and complete. If employed, any misstatement or omission of fact on the application may result in my dismissal.

I understand that acceptance of an offer of employment does not create a contractual obligation upon the employer to continue to employ me in the future. All employment is at-will.

I authorize the company to verify any information on this application and check references and background.

If you decide to engage an investigative consumer reporting agency to report on my credit and personal history I authorize you to do so. If a report is obtained you must provide, at my request, the name of the agnecy so I may obtain from them the nature and substance of the information contained in the report.

I understand that I will be required to provide a signature for all information provided on this form before employment.
Pioneer Contract Services, Inc.
8090 Kempwood • Houston, TX 77055
Phone: 713-464-8200
Fax: 713-464-7100
© Copyright 2005, Pioneer Contract Services, Inc.

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