Employment Application

Applicant Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Date Available*

Wage Asking*

Are you legally eligible to work in the U.S.?*

Yes
No

Have you ever been convicted of a felony?*

Yes
No

If yes, please explain.*

Have you ever been convicted of a DUI?*

Yes
No

How long ago?*

Certifications

EPA Certificate*

Universal
Type 1
Type 2
Type 3
No Certifications

Education

High School*

City*

State*

From*

To*

Did You Graduate?*

Yes
No

College

City

State

From

To

Did You Graduate?

Yes
No

Degree

Other

From

To

Did You Graduate?

Yes
No

Degree

Employment History

Company*

From*

To*

Address*

Phone

Supervisor*

Responsibilities*

Wages

May we Contact?*

Yes
No

Company*

From*

To*

Address*

Phone

Supervisor*

Responsibilities*

Wages

May we Contact?*

Yes
No

Company*

From*

To*

Address*

Phone

Supervisor*

Responsibilities*

Wages

May we Contact?*

Yes
No

Disclaimer and Consent*

I agree to the following:

I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired.

I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information.

In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me.

I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself.