GSI Engineering
Employment Application
An Equal Opportunity Employer


We have six Midwest offices: Wichita, Manhattan, Kansas City, and Salina, Kansas; Grand Island, Nebraska; and Des Moines, Iowa.  For more information,
go to our
Web site.

We are an equal opportunity employer and do not unlawfully discriminate in employment.  No question on this application is used for the purpose of limiting
or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law.  Equal access to employment, services,
and programs is available to all persons.  Those applicants requiring reasonable accommodation to the application and/or interview process should notify a
representative of GSI.

Instructions:

  • Fully complete this application.
  • If a question does not apply to you, type "N/A" in the box.
  • Please read and click the Acknowledgements at the bottom of the application.

Position applied for:

 

Last name:

 

First name:

 

Middle initial:

 

 E-mail address:

Social Security Number:

 

Street address:

 

City:

 

State:

 

Zip code:

Telephone number:

Date you are able to begin work:

Desired salary:

Best time to contact you at home is:

  am pm 

Have you ever filed an application
with our company?

  Yes No 

If yes, provide date:

Have you ever been employed
with our company?

  Yes No 

If yes, provide dates and job title:

Can you, after employment, submit verification
of legal employment
authorization and identity?

  Yes No 

If you are under 18 years of age,
can you provide required proof of
your eligibility to work?

  YesNoNot applicable

Can you travel if required
by the position you are applying for?

  Yes No 

Are you currently employed?

  Yes No 

May we contact your present employer?

  Yes No 

Are you available to work:

  Full Time Part Time Temporary 

Have you ever been convicted of a crime?

  Yes No 

If yes, please describe:
*NOTE: Criminal convictions are not an
absolute bar to employment,
but will be considered only
in relation to specific job requirements.

You may be asked to drive
on company business.
Do you have a valid driver's license?

  Yes No 

Within the last five (5) years,
have you been convicted of (or forfeited bond
or collateral for) any violation
of the motor vehicle laws or ordinances
(except parking tickets) of any city or state?

  Yes No 

If the answer to the above question is Yes,
you must identify the nature, date,
and any facts or circumstances
of each traffic conviction and any facts
that you feel might be relevant
to such traffic convictions.

For job positions that may involve field and/or lab work, you must be able to safely perform the following functions:
Ability to lift 75 lbs.
Follow established test procedures.
Sample retrieval and soil handling.
Assist in well installation and completion.
Wear a respirator on environmental jobs.
Conduct sampling and casting of fresh concrete.
Conduct compaction testing.
Have good communication and writing skills.
Other related job duties as required or assigned.

Are you able to perform all the
functions of the job position
for which you are applying?

  Yes  No  

If No, please indicate reason: 


 
EDUCATIONAL BACKGROUND
List school name, location, years completed, field of study or area of concentration, and any diploma or degrees earned:
 

School Name

Location

Years Completed

Field of Study
or Area of Concentration

Diploma/Degree Earned

High School
College
Tech/Trade School
Other

 
EMPLOYMENT EXPERIENCE/WORK RECORD:
In order to verify that you meet the qualifications, this section must be filled out completely even if a resume is attached.  This information is required for
application processing.  If this information is not complete, the application will be returned to you.

List the positions that you have held, starting with your current or most recent.  If you held more than one position with the same organization, or if you
were in the military and had multiple assignments, list each separately.

Employer:

Supervisor:

Address:

Phone number:

Dates of employment:

From:

To:

 

Beginning Salary:

Ending Salary:

Position held:

Reason for leaving:

Duties:


Employer:

 Supervisor:

Address:

 Phone number:

Dates of employment:

From:

To:

 

Beginning Salary:

Ending Salary:

Position held:

 Reason for leaving:

Duties:

   

Employer:

Supervisor:

Address:

 Phone number:

Dates of employment:

From:

To:

 

Beginning Salary:

Ending Salary:

Position held:

Reason for leaving:

Duties:

   

Employer:

Supervisor:

Address:

 Phone number:

Dates of employment:

From:

To:

 

Beginning Salary:

Ending Salary:

Position held:

Reason for leaving:

Duties:

   
 

REFERENCES:
List names and phone numbers for three individuals in supervisory or co-worker capacity who can attest to your abilities.

Paste your cover letter and resume in the fields below:

(To retain Word formatting, use the "Paste from Word" button .)

Cover Letter:

Resume:

 


ACKNOWLEDGEMENTS:
Please read and agree to the following:

I certify that all statements I have made in this application are true and agree that any misrepresentation or omission of facts requested may be sufficient cause for cancellation of my application or immediate dismissal from GSI, if I have been employed.  In the event I am employed, I agree to conform to the rules and policies of GSI.  I understand that these rules and policies may be changed, interpreted, withdrawn, or added to at GSI's option at any time without notice. 

I agree


I understand that employment is contingent upon meeting the physical requirements of the job and passing, to GSI's satisfaction, a drug screen.  A post-hire physical examination may also be required if applicable to the offered job description.  All pre-employment/post-hire drug and medical tests are at the expense of GSI.

I agree


I understand that federal law prohibits the employment of unauthorized aliens and that all persons hired must submit satisfactory proof of employment authorization and identity within three days of being hired.  I further understand that failure to submit such proof within the required time will result in my immediate dismissal.

I agree


I understand that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or GSI's option.  I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by GSI.  I understand that no GSI representative, other than its President, and then only in writing, and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

I agree


I acknowledge GSI's notification to me that a background investigation which includes, among other things: motor vehicle records; federal, state and county criminal history records; previous employers; professional licensing authorities; and educational institutions.  I understand that my disclosure of prior convictions for criminal or traffic offenses will not necessarily prevent my employment with GSI; however, the omission of this requested information will be sufficient cause for cancellation of my application or my immediate dismissal from GSI.  I understand and agree that successful completion to GSI's satisfaction of such investigation(s) is required for employment or continued employment.  I hereby authorize GSI to conduct or have conducted the investigation(s) described above and to prepare to cause to be prepared a report based on such information.  I further understand that, upon my written request, a complete disclosure of the nature and scope of the investigation(s) conducted will be provided to me.

I agree

Maiden or other names formerly used:

Date last used:

Date of birth:

Driver's license number:

State issued in:


Current Address:

City:

State:

Zip code:

County:

Home phone number:


Previous address:

City:

State:

Zip code:

County:

From date: 
    To date:


Previous address:

City:

State:

Zip code:

County:

From date: 
    To date:


I have read and agree to the above acknowledgements.

I agree