Septic Truck Driver / Service Technician

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Equal Opportunity Employer It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability, or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to answer all of the questions on this application completely. You may attach a résumé, but all questions must be answered.

Name

Phone

Email

Address

Date You Can Start

High school diploma or GED?

Yes No

Hours

Full-Time Part-Time

Shifts

Days Evenings

Shifts Con't

Swing Graveyard Weekends

Status

Regular Temporary

Are you authorized to work in the U.S. on an unrestricted basis?

Yes No

Have you ever been convicted of a felony? (Convictions will not necessarily disqualify an application for employment.)

Yes No

If yes, please explain:

Have you been told the essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job?

Yes No

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes No

Please list any education or training you feel relates to the position applied for that would help you perform the work such as schools, colleges, degrees, vocational or technical programs, and military training.

Qualifications & Education

List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)

Please list three professional references not related to you with full name, address, phone number, and relationship. If you don't have three professional references, then list personal, unrelated references.

Reference 1 Name

Reference 1 Address

Reference 1 Phone

Reference 1 Relationship

Reference 2 Name

Reference 2 Address

Reference 2 Phone

Reference 2 Relationship

Reference 3 Name

Reference 3 Address

Reference 3 Phone

Reference 3 Relationship

Start with your present or most recent employment and work back. Include paid and unpaid positions.

Job Title 1

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary/Wage

Ending Salary/Wage

May we contact this employer

Yes No

Job Title 2

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary/Wage

Ending Salary/Wage

Job Title 3

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary/Wage

Ending Salary/Wage

Job Title 4

Start Date

End Date

Company Name

Supervisor's Name

Phone Number

City

State

Zip

Duties

Reason for Leaving

Starting Salary/Wage

Ending Salary/Wage

Integrity Statement

I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if fI am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on this application.

At Will Employer

I acknowledge and understand that the company is an "at will" employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause, with or without notice to the other party.

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