Assistant Pump Installer - Applicant Questionaire

Welcome

Thank you for your interest in applying for an Assistant Pump Installer position with Municipal Well & Pump.  We are glad you are considering joining our team.  Our Company takes pride in the work we do and we are always looking for employees who have a passion to work hard, to work safe and to make a good living.  You will be challenged, you will learn new skills, but you will also be rewarded both in accomplishment and in a very competitive salary and benefits package.

Listed below is a job description and a list of the skills needed.  If you feel this is the type of work you would like to do, we invite you to complete the application below.

Job Description / Responsibilities:

You will work on a team of 2 or 3 employees to install, remove and repair large diameter well pumps for municipalities, industry or irrigation clients.  Other projects include repairing and rehabilitating water wells to improve water production for the client.  Municipal Well & Pump services clients through Wisconsin, northern Illinois, eastern Iowa, northwestern Indiana and the UP of Michigan.  This requires our crews to travel and stay away from home during the week if the job is more than 1 hour from Waupun, WI.  You will be driving pump rigs or service trucks with trailers to job sites.  Nearly all of our vehicles are consider commercial motor vehicles per USDOT which requires you to have a CDL license.  Crew members need to be flexible in their skill sets including running various construction equipment, welding, mechanical piping, equipment repairs, electrical troubleshooting, etc.  You will be expected to work in all weather conditions - cold, hot, rain, snow, wind - unless we shut down due to safety factors.

Expectations & Skills Required of Prospective Employee:

  • Good physical condition - able to be on your feet the majority of the day.
  • Lifting - able to lift 80 to 100 lbs multiple times throughout the day.
  • Capable of regular bending, stooping, walking and pulling without physical pain.
  • Driving Record - needs to be fairly clean.  No DUI's.
  • Commercial Drivers License - needed (or will need to be obtained shortly after hire).
  • Fluently speak, write and understand English
  • Graduated from High School
  • ​Pass a drug and alcohol screening, medical exam & a physical strength and endurance test.
  • Stay away from home as needed (averaging 45% to 50%of the time).

Application Terms - TO BE READ and SIGNED by APPLICANT before proceeding:

Please click here to read the Application Terms.

1.
*

I have read the application terms and agree to them.

Yes   No
2.
*

Please sign (enter your full name) acknowledging that you agree.


Applicant Profile:

3.
*

First Name

4.
*

Last Name

5.
*

Current Address

6.
*

City

7.
*

State

8.
*

Zip Code

9.
*

Phone #

10.
*

Do you have legal right to work in the United States?

Yes   No
11.
*

Enter Birth Date (mm/dd/yy)
This is required field for Commercial Drivers


Employment History

All driver applicants to drive in interstate  commerce must provide the following information on all employers during the preceding 3 years.  Please list complete mailing address, street number, city state and zip codes.  Additionally, since this position requires applicants to drive a commercial vehicle (definition below), in interstate and intrastate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicles.

A commercial vehicle includes vehicles with a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

Please list all references in reverse order starting with the most recent.


Employer #1

12.
*

Employer Name

13.
*

Start Date (MM/YYYY)

14.
*

End Date (MM/YYYY or "Now" if still working)

15.
*

Position Held

16.
*

Hourly Rate

17.
*

Reason for leaving (or reason you are looking to leave if still working)

18.
*

Address

19.
*

City

20.
*

State

21.
*

Zip

22.
*

Contact Person

23.
*

Contact Phone #

24.
*

Were you subject to the FMCSRs while employed?

Yes   No
25.
*

Was your job subject to Drug and Alcohol Testing per the requirements of DOT regulation 49 CFR Part 40?

Yes   No

Employer #2 (if applicable)

26.

Employer Name

27.

Start Date (MM/YYYY)

28.

End Date (MM/YYYY)

29.

Position Held

30.

Hourly Rate

31.

Reason for leaving

32.

Address

33.

City

34.

State

35.

Zip

36.

Contact Person

37.

Contact Phone #

38.

Were you subject to the FMCSRs while employed?

Yes   No
39.

Was your job subject to Drug and Alcohol Testing per the requirements of DOT regulation 49 CFR Part 40?

Yes   No

Employer #3 (if applicable)

40.

Employer Name

41.

Start Date (MM/YYYY)

42.

End Date (MM/YYYY)

43.

Position Held

44.

Hourly Rate

45.

Reason for leaving

46.

Address

47.

City

48.

State

49.

Zip

50.

Contact Person

51.

Contact Phone #

52.

Were you subject to the FMCSRs while employed?

Yes   No
53.

Was your job subject to Drug and Alcohol Testing per the requirements of DOT regulation 49 CFR Part 40?

Yes   No

Employer #4 (if applicable)

54.

Employer Name

55.

Start Date (MM/YYYY)

56.

End Date

57.

Position Held

58.

Hourly Rate

59.

Reason for leaving

60.

Address

61.

City

62.

State

63.

Zip

64.

Contact Person

65.

Contact Phone #

66.

Were you subject to the FMCSRs while employed?

Yes   No
67.

Was your job subject to Drug and Alcohol Testing per the requirements of DOT regulation 49 CFR Part 40?

Yes   No

Driving History

Accident Record

68.
*

Have you had any driving accidents within the last 3 years?

Yes   No

If you had an accident in the last 3 years please answer the following questions. If not, please skip to question #75.

69.

Date of Accident #1 (MM/YYYY)

70.

Nature of Accident (head on, rear-end, flip over, etc)

71.

Please check the appropriate box (or boxes) if the accident resulted in any of the following:

Fatalities   Injuries   Hazardous Material Spill   None of these
72.

Date of Accident #2 (MM/YYYY)

73.

Nature of Accident (head on, rear-end, flip over, etc)

74.

Please check the appropriate box (or boxes) if the accident resulted in any of the following:

Fatalities   Injuries   Hazardous Material Spill   None of these

Traffic Convictions

75.
*

Have you had any traffic convictions and / or forfeitures in the past 3 years (do not include parking violations)?

Yes   No

If you had a traffic conviction in the last 3 years please answer the following questions. If not, please skip to question #85.

76.

Enter location of Traffic Conviction #1 (City, State)

77.

Date of Conviction (MM/YYYY)

78.

Resulted in (check all that apply)

Arrest   Fine   Forfeiture of License   Loss of Points
79.

Enter location of Traffic Conviction #2 (City, State)

80.

Date of Conviction (MM/YYYY)

81.

Resulted in (check all that apply)

Arrest   Fine   Forfeiture of License   Loss of Points
82.

Enter location of Traffic Conviction #3 (City, State)

83.

Date of Conviction (MM/YYYY)

84.

Resulted in (check all that apply)

Arrest   Fine   Forfeiture of License   Loss of Points
85.
*

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes   No
86.
*

Has any license, permit or privilege ever been suspended or revoked?

Yes   No
87.

If the answers to either Q 85 or Q 86 is yes, please give details below.


Driving Experience

88.
*

Do you have experience driving a commercial vehicle?

Yes   No

If you have experience driving a commercial vehicle please answer the following questions. If not, please skip to question #94

89.

Please check all the states below that you have driven commercial vehicles in over the last 5 years

WI   IA   IL   IN   MI   MN   Others   None
90.

I have experience driving the following types of commercial vehicles (check all that apply).

Straight Truck   Tractor & Semi-Trailer(s)   Motor Coach - School Bus   Other (explain below)
91.

Explanation of Other Commercial Vehicle type

92.

Enter total years of experience in driving commercial vehicles

93.

Enter approximate number of all-time total miles driving commercial vehicles


Experience and Qualifications

94.
*

Please check all the areas that you have previous job related experience

(1 required)
Backhoe   Crane Operation   Electrical   Electrical Controls
Excavation   Forklifts   General Building Construction   Plumbing
Pump Installation   Pump Repairs   Trenching   Skid Steers
Small Engine Repairs   Vehicle Repairs   Welding   Well Drilling
Other - explain below   None of these
95.
*

Provide a written explanation of your experience in the areas checked above (be specific)

96.
*

Please list any specific training courses you have taken that will assist you in this position

97.

Please list any other qualifications that you believe will be beneficial in making you successful in this position


Education

98.
*

Did you graduate from High School?

Yes   No
99.
*

How many years of schooling have you attended past High School?

1   2   3   4   More Yet   None
100.

Please indicate any specific degrees you have obtained after high school

101.

Please list any specific awards you have received either in school or after attending school.

102.
*

Enter the name of the last school you attended

103.
*

Enter the City and State of the last school you attended


Motor Vehicle Record Release Form:

One aspect of evaluating your application is to review your driving record.  In order to drive for Municipal Well & Pump with a CDL our insurance company will verify your Driver Motor Vehicle report and inform us whether we may proceed with hiring you.

Please download the DMV Release and Authorization form.

Please fill out the form electronically before signing the document .  

  • Under the name field please list your full name (First, Middle & Last)
  • Fill in all the other fields, other than the signature
  • Print and sign the form
  • Then you will need to scan back to an electronic file (either JPG or PDF) and reattached the file below.  If you don't have a scanner, you can take a picture and reattached the picture below.

 

104.
*

Please upload your completed "Motor Vehicle Record Release Form"


(allowed file types: gif,jpg,pdf,png)

Self Identification Form:

Midwest Well Services, Inc. (MWS) is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights and regulations. In order to comply with these laws, MWS invites employees and prospective employees to voluntarily self-identify their sex, race, ethnicity, veteran status and disability.  Although we are asking you to complete this survey to assist us in complying with federal reporting requirements, doing so is completely voluntary. You will suffer no adverse consequences if you do not provide this information. The information will be kept confidential and will be used only in accordance with applicable law, executive orders, and regulations, including those that require MWS to summarize and report the information it collects to the federal government and certain state and municipal clients.

For a further explanation of why we ask for this information and for a list of definitions needed to complete this form - please click here

105.
*

Veteran Status:  (please check one)

(1 required)
Non Veteran   Disable Veteran
Other Protected Veteran   Three Year - recently released Veteran
Armed Forces Service Medal Veteran   I choose not to answer
106.

If recently discharged, please enter release date (MM/DD/YYYY)

107.
*

Ethnicity: (select one)

(1 required)
HIspanic or Latino - A person of Cuban, Mexican, Puerto Rican, South and Central American, or other Spanish culture or origin regardless of race
Not Hispanic or Latino
I choose not to answer
108.
*

Race: (select one or more)

(1 required)
American Indian or Alaskan Native - A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Vietnam, etc.
Black or African American - A person having origins in any of the Black racial groups of Africa
Native Hawiian or other Pacific Islander - A person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa
I choose not to answer
109.
*

Gender:

(1 required)
Male   Female
110.
*

Disability:  Do you have a disability?

(1 required)
Yes   No   I choose not to answer

Midwest Well Services, Inc. considers a person with a disability anyone who meets the definition under either the American with Disabilities Act or the Wisconsin Fair Employment Act.  

If you need reasonable accommodation(s) during the application process due to disability related functional limitations, please notify our office (either Shelly or Scott) - call 800-383-7412.

111.
*

I need an accommodation in the hiring/examination process

Yes   No
112.

If yes, accommodation requested is (i.e., extended time, reader, alternative test format, other)

**You will be required to provide written verification from a doctor or other authorized person confirming your disability and indicating reasonable accommodation.

113.
*

How did you learn of this Job Opportunity:

(1 required)
Municipal Well & Pump Bulletin Board   Municipal Well & Pump Website
Job Center of Wisconsin Website   Local Newspaper (list name below)
Local Technical College Website   Monster.com internet posting
Unemployment Office   WisconsinDiversity.com internet positing
Word of Mouth   Other (explain below)
Referred by MWP Employee
114.

If you selected Newspaper above, please list the name of the paper.

115.

If you were referred by a MWP Employee, please list their name

116.

If you selected Other above, please explain


Upload Documents:

If you would like to upload a full resume or a cover letter you may do that below.

117.

Here is my Resume


(allowed file types: doc,docx,pdf)
118.

Here is my cover letter.


(allowed file types: doc,docx,pdf)

Applicant Signature:

Affirmative Action Policy:  In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without reqard to race, color, religion, sex, national origin, age, marital status, no-job related disability, or any other protected group status.

Certification of Job Application:  This certifies that this application was completed by me, and that all entries on it and the information in it are true and complete to the best to my knowledge.

119.
*

Please sign below to acknowledge the above statements:

Enter your full name

* Email Address:

The captcha you entered is incorrect, please try again