Job# 190, Position: Internship at Utah Custom Fabrication - Ogden Utah
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Contact Information
Name Prefix
First Name
Middle
Last Name
Name Suffix
Preferred Name
Address
Address 2
City
State
Zip
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Phone 1
Phone 2
Best Time to Call
Email
Personal Information
Over 18 Yes    No   
Petersen Inc. Participates in E-Verify.
Legal to Work in USA Yes    No   
Prior Petersen Inc Employment
Work for Petersen Inc Before Yes    No   
If so, when
Referred Source
Source Name
Employment Desired
Location Ogden Utah
Position Internship
Hours per Week 40
Work Shift Any    Day    Swing   
Wage Desired
Date Available
Skills
Skills / Certificates

(if applicable include
specific welding skills)
Leadership Skills and Experience
Education
Highest Education
Total Years Completed
Major/Minor
or
Courses Taken
Pre-Employment Confidential EEO Data
Petersen Incorporated is a Government contractor subject to Executive Order 11246, and to the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. These regulations require Government contractors to take affirmative action. The following information will assist us in an appropriate position. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. Information you submit will be kept confidential except to government officials engaged in enforcing laws administered by OFCCP.
Agree to EEO *** Yes    No   
*** Note: Submiting EEO data is not required. If you choose not to submit this data, it will not effect whether one is or is not hired.
Gender Male    Female    Decline   
Ethnicity
US Veteran Yes    No    Decline   
Disabled US Veteran Yes    No    Decline   
US Vietnam Veteran Yes    No    Decline   
US Veteran Recently Separated Yes    No    Decline   
*** What is a disability? A person has a disability if he or she has a physical or mental impairment or a medical condition that substantially limits a major life activity, or has a history or record of such an impairment or medical condition.
Disabled Yes    No    Decline   
Employment History 1
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Start - End Dates
Start - End Wages
Position Held
Supervisor
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Reason for Leaving
Employment History 2
Company
Address
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State / Zip
Web Site
Phone
Start - End Dates
Start - End Wages
Position Held
Supervisor
Duties / Responsibilities
Reason for Leaving
Employment History 3
Company
Address
City
State / Zip
Web Site
Phone
Start - End Dates
Start - End Wages
Position Held
Supervisor
Duties / Responsibilities
Reason for Leaving
Reference 1
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Years Known
Reference 2
Name
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Years Known
Reference 3
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Phone
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Years Known
Petersen Inc. is an equal opportunity employer and offers employment to qualified individuals regardless of their race, color, religion, sex, national origin, age physical or mental handicap, veteran or disabled veteran status, and conforms to all applicable laws and regulations. It is understood and agreed upon that any misrepresentation by me in this application will result in cancellation of this application and, if employed, my employment may be terminated at any time. Furthermore, I understand that my employment is at-will, which means that just as I am free to resign at any time, the employer reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the employer has the authority to make any assurances to the contrary. I give the employer the right to investigate all references, criminal background checks, and to secure additional truthful information about me, if job related. I hereby release from liability the employer and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. I authorize the Company to release to any person, firm, entity or organization with which I may seek employment in the future, any truthful information concerning my work experience with the Company. I hereby release and hold the Company harmless from any claim for releasing any truthful information within its knowledge and/or records. I hereby voluntarily consent to a physical examination and/or tests to be conducted by company-designated physicians and/or other appropriate medical personnel. If employment is offered, I specifically volunteer for testing to determine the presence of drugs and/or alcohol in my system. I voluntarily authorize the release of the test results to the management of this company for use in determining my eligibility for employment. I understand that only those applicants with a negative drug and/or alcohol test result will be considered for employment. I also understand that if after testing has occurred and I decline the offer of employment, I will be fully responsible for reimbursing Petersen Inc the cost of the test.
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Job# 190, Position: Internship at Utah Custom Fabrication - Ogden Utah