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Welcome to Buckner's Welding LLC

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Exceptional Services for Your Next Project

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Position

First name

Last name

Birthday

Month

Day

Year

Address

Phone

Emergency Contact

Emergency Contact Number

Do You Have A Current Valid Driver's License And Good Driving Record?

Yes

If No, Please Explain

THIS IS A SAFETY SENSITIVE POSITION

Do You Have Any Physical Restrictions Which Would Affect Your Ability To Do The Job For Which You Are Applying

Yes

Please Describe Any Medical Conditions You Have Been Treated For In The Past 6 Months And List All Medications You Take In Relation To Any Medical Conditions You Have.

DRUG TEST ARE MANDATORY AND WILL BE SCHEDULED UPON EMPLOYMENT.

Please List Machinery you operate and/or Welding Certification

Do You Have Current MSHA Training?

Yes

Employment History

Present Or Most Recent Position: Job Title

Employer

Address

Phone

Supervisor's Name

Provide Dates Employed

Duties

May We Contact Your Present Employer/Supervisor

Yes

Previous Or Last Position: Job Title

Employer

Address

Phone

Supervisor's Name

Provide Date's Employed

Duties

Reason For Leaving Previous Job

Have You Ever Been Convicted Of Felony

Yes

If So, Dates Of Conviction

Reason For Conviction

You May Attach A Resume Or Any Additional Information Below.

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Date

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Office

109 E Main St

Stigler, Oklahoma

(918) 617-1077

sales@bucknerswelding.com

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Inquiries

For any inquiries, questions or commendations, please call: (918) 617-1077

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