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PLEASE PRINT CLEARLY AND PROVIDE ALL REQUESTED INFORMATION - PowerPoint PPT Presentation


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APPLICATION FOR EMPLOYMENT DATE: ________________________. PLEASE PRINT CLEARLY AND PROVIDE ALL REQUESTED INFORMATION. NAME ____________________________________________________________________________________________________________ STREET ADDRESS

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APPLICATION FOR EMPLOYMENT

DATE: ________________________

PLEASE PRINT CLEARLY AND PROVIDE ALL REQUESTED INFORMATION

NAME

____________________________________________________________________________________________________________

STREET ADDRESS

____________________________________________________________________________________________________________

HOME PHONE # ( ) CELL PHONE # ( )

POSTION DESIRED

(A SEPARATE APPLICATION MUST BE PROVIDED FOR EACH POSITION IN WHICH YOU ARE INTERESTED)

POSITION APPLYING FOR: _____________________________________________________________________________________

TYPE OF WORK DESIRED: FULL TIME PART TIME EITHER

PERSONAL INFORMATION

IF HIRED, CAN YOU PRESENT EVIDENCE OF YOUR U.S. CITIZENSHIP OR YES NO

PROOF OF YOUR LEGAL RIGHT TO LIVE AND WORK IN THE UNITED STATES?

ARE YOU ON ANY MEDICATIONS THAT WOULD EFFECT YOUR ABLITITY TO PERFORM YES NO

YOUR JOB SAFELY AND EFFECTIVELY? IF YES, PLEASE EXPLAIN.

DO YOU HAVE ANY METAL OR PHYSICAL ILLNESSES THAT WOULD EFFECT YOUR JOB YES NO

PERFORMANCE? IF YES, PLEASE EXPLAIN,

HAVE YOU EVER RECEIVED ANY TRAFFIC VIOLATIONS OR HAD ANY ACCIDENTS IN THE YES NO

LAST THREE YEARS? IF YES, PLEASE EXPLAIN.

DO YOU HAVE A CDL? IF YES, PLEASE LIST ITS CLASS, ANY ENDORSEMENTS AND/OR YES NO

RESTRICTION.

HAVE YOU EVER BEEN CONVICTED OF A CRIME? IF YES, PLEASE EXPLAIN. YES NO

REFERENCES

NAME ADDRESS TELEPHONE # RELATIONSHIP YEARS KNOWN

___________________________ __________________________________ ______________ ______________ ______________

___________________________ __________________________________ ______________ ______________ ______________

__________________________ __________________________________ ______________ ______________ ______________

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 accommodations to the application and/or interview process should contact the Human Resources Office.

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EMPLOYMENT HISTORY

EMPLOYER: __________________________________________________________MAY WE CONTACT THEM? ______________

ADDRESS:_______________________________________________________________ PHONE: ___________________________

SUPERVISIORS NAME: ____________________________________________ EMPLOYMENT DATES: ______________________

ENDING SALARY: ________________________________ TITLE OR POSITION: _________________________________________

DUTIES/RESPONSIBILITIES: __________________________________________________________________________________

REASON FOR LEAVING: ______________________________________________________________________________________

EMPLOYER: __________________________________________________________MAY WE CONTACT THEM? ______________

ADDRESS:_______________________________________________________________ PHONE: ___________________________

SUPERVISIORS NAME: ____________________________________________ EMPLOYMENT DATES: ______________________

ENDING SALARY: ________________________________ TITLE OR POSITION: _________________________________________

DUTIES/RESPONSIBILITIES: __________________________________________________________________________________

REASON FOR LEAVING: ______________________________________________________________________________________

EMPLOYER: __________________________________________________________MAY WE CONTACT THEM? ______________

ADDRESS:_______________________________________________________________ PHONE: ___________________________

SUPERVISIORS NAME: ____________________________________________ EMPLOYMENT DATES: ______________________

ENDING SALARY: ________________________________ TITLE OR POSITION: _________________________________________

DUTIES/RESPONSIBILITIES: __________________________________________________________________________________

REASON FOR LEAVING: ______________________________________________________________________________________

EDUCATION

TYPE OF SCHOOL NAME AND LOCATION # OF YEARS DID YOU MAJOR/

COMPLETED GRADUATE? DEGREE

HIGH SCHOOL/

GED __________________________________________ _____________ _____________ _____________

BUSINESS/TRADE OR

TECHNICAL SCHOOL __________________________________________ _____________ _____________ _____________

COLLEGE OR

UNIVERSITY(S) __________________________________________ _____________ _____________ _____________

CERTIFICATION

IMPORTANT. PLEASE READ CAREFULLY AND SIGN.

I hereby certify that the information on this application and all other information otherwise provided are true and correct. I

understand that any misrepresentations or omissions will be sufficient cause for cancellation of this application or immediate

termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and this application does not constitute an

agreement or contract for employment.

I authorize Bloom Waste Services, LLC to review past employers, personal references and public records. I further authorize

Bloom Waste Services to perform any type of background check, including but not limited to, credit and criminal.

I represent and warrant that I have read and fully understand the foregoing, and that I seek employment under these conditions.

Applicant’s Signature_______________________________________________________________ Date_________________

EMPLOYEER COMMENTS: ____________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________