Employment Application | English | Dixie Southern

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Steel Plate Fabricator Since 1976

12650 County Road 39 Duette, FL 34219

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ASME Pressure Vessels & Tanks

Rolled and Welded Steel Pipe

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All Applicants Have Rights Under Federal Employment Laws

Family and Medical Leave Act (FMLA)
Equal Employment Opportunity (EEO)
Employee Polygraph Protection Act (EPPA)
Are you 18 years of age or older?*
- Yes
- No
Date of Birth*
MM slash DD slash YYYY
Name*
Prefix First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

Were You Referred By Someone?*
Would you like to be interviewed today if available?*
- Yes
- No
Position Desired*
If Other, Input Position
Date You Can Start*
MM slash DD slash YYYY
Salary Desired (Hourly)*

Are You Employed Now?*
- Yes
- No
Currently Employed Where and For How Long?
May We Inquire Of Your Present Employer?
- Yes
- No

List below your last two employers, starting with the last one first
Employer #1*
Employed FROM and TO Dates*
Rate of Pay Employer #1?
Position Upon Leaving Employer #1?
Reason for Leaving Employer #1?*
Former Employer #2
Employed FROM and TO Dates at Employer #2
Rate of Pay Employer #2?
Position Upon Leaving Employer #2?
Reason for Leaving Employer #2?

Did You Graduate High School?*
- Yes
- No
High School*
What Year Did You Graduate High School?*
Subjects Studied and Degree(s) Received in High School?*
Did You Attend College?*
- Yes
- No
College
Did You Complete College?*
- Yes
- No
College Years Completed
Area of Study
Did You Attend a Trade, Business or Correspondence School?*
- Yes
- No
Trade, Business or Correspondence School Location?
Did You Graduate Trade School?*
- Yes
- No
Year You Completed Trade School?
Subjects Studied and Degree(s) Received at Trade School?

Any Subjects of Special Study or Research Work?*
Job Related Skills*
Activities Other Than Religious (Civic, Athletic, etc.)*
*exclude organizations, the name or character of which indicates the race, sex, color or national origin of its members.
Consent*
I agree to the consent policy.
Consent & Disclosure for Background Identification Verification
IN ORDER TO VERIFY MY IDENTITY FOR THE PURPOSES OF BACKGROUND IDENTIFICATION FOR EMPLOYMENT WITH DIXIE SOUTHERN & SOUTHEASTERN CONSTRUCTION AND MAINTENANCE, INC., I AM VOLUNTARILY RELEASING MY DATE OF BIRTH, SOCIAL SECURITY NUMBER, AND OTHER INFORMATION AS MAY BE REQUIRED TO VERIFY IDENTIFICATION AND BACKGROUND INFORMATION. I FULLY UNDERSTAND THIS INFORMATION IS FOR MY BENEFIT IN SEEKING EMPLOYMENT, AND THAT ALL DECISIONS FOR EMPLOYMENT ARE BASED ON LEGITIMATE NON-DISCRIMINATORY BASIS.

Corporate Office
1150 Pebbledale Rd. Mulberry, FL 33860
Mailing Address
PO BOX 1055 Mulberry, FL 33860
Phone
863.428.1511

Fabrication Facility
12650 County Road 39 Duette, FL 34219
Phone
941.776.1212

Email
sales@dixiesouthern.com

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