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2019-05-30T19:10:12+00:00
Application
Summit Environmental Services, LLC Employment Application
The following information is requested in order to help us make a thorough evaluation of your request for employment. All portions of this application must be completed. If a question does not pertain to you, please mark it "NA".
Current Date
*
MM slash DD slash YYYY
Date Available for Work?
*
MM slash DD slash YYYY
Position Desired?
*
Salary Desired?
*
Personal Data
Name
*
First
Last
SSN#
*
Have you ever worked under another name?
*
Yes
No
If yes, given name:
*
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
Check type of employment
*
Select One
Full Time
Part Time
Temporary
Over the age of 18?
*
Yes
No
A previous applicant?
*
Yes
No
A previous employee?
*
Yes
No
Legally able to work in the United States?
*
Yes
No
Other than traffice violations, have you ever been convicted of a crime? Yes - No (Conviction is not necessarily a bar to employment)
*
Yes
No
If yes, describe in detail:
*
Work Experience
Begin with your current job and work backward in order, listing your current and previous two employers including all full-time and part-time employment. All time must be accounted for including military service, self-employment and periods of unemployment.
Present/Last Employer:
Phone
Type of business:
Start Date
MM slash DD slash YYYY
Leave Date
MM slash DD slash YYYY
Salary:
Job Title
Supervisor & Title:
May we contact?
Yes
No
Reason for leaving?
Description of job and duties:
Previous Employer:
Phone
Type of business:
Start Date
MM slash DD slash YYYY
Leave Date
MM slash DD slash YYYY
Salary:
Job Title
Supervisor & Title:
May we contact?
Yes
No
Reason for leaving?
Description of job and duties:
Previous Employer:
Phone
Type of business:
Start Date
MM slash DD slash YYYY
Leave Date
MM slash DD slash YYYY
Salary:
Job Title
Supervisor & Title:
May we contact?
Yes
No
Reason for leaving?
Description of job and duties:
Education and Training
Name of High School
*
School Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Field of Study?
Did you graduate?
*
Yes
No
Degree Earned:
Name of College/Tech School
School Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Field of Study?
Did you graduate?
Yes
No
Degree Earned:
Other Training
School Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Field of Study?
Did you graduate?
Yes
No
Degree/Certification Earned:
Additional Qualifications
What knowledge, skills, and/or individual capabilities do you have which especially prepare you for the position you have applied for?
Military
Branch of Service:
Rank at Discharge:
Dates of Service:
List duties in the sevice, including schools and training:
References
Please provide three references other than family members:
Name
First
Last
Phone
Occupation
Name
First
Last
Phone
Occupation
Name
First
Last
Phone
Occupation
I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsifications of this application in any detail is grounds for disqualification from further consideration or for dismissal from employemnt regardless of when the falsification is discovered. By signing this application, I am authorizing the Company to contact my previous employers. I am also authorizing my previous employers to release information about me that they have knowledge of or that may be contained in their records regarding my record of service, conduct, attendance and character. I do hereby release my previous employers from any and all liability which may result from providing such information to the Company.
*
I understand and accept conditions
Electric Signature - Please type your First and Last Name.
*
Electric Signature - Date
*
Resume
Max. file size: 256 MB.
Cover Letter
Max. file size: 256 MB.
Misc.
Max. file size: 256 MB.
All qualified applicants receive consideration for employment without regard to race, color, religion, sex, age, national origin or veteran status.
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