American Leakless Company, LLC

Employment Application

ALL APPLICANTS MUST PASS A DRUG SCREEN AND BACKGROUND CHECK

Date:

Last Name: First Name: Middle Name:

Street Address:

City: State/Region: Postal/Zip Code:

Home Phone: Cell Phone:

Social Security Number: Date of birth:

Position Applied For: Desired Wage: $

Employment desired: Full Time Part Time Date available to start:

Hours available: Sun Mon Tue Wed Thu Fri Sat

Are you willing to work swing shift?: Yes No Are you willing to work graveyard shift: Yes No

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis?: Yes No

Have you ever been convicted of a felony?: Yes No

If yes, explain including offense, date, sentence, and rehab:

Type of School

Name of School

Mailing Address

Years Completed

Major & Degree

High School

College

Professional School

Other

List certifications:

Please list two references other than relatives or previous employers:

Name:

Name:

Address:

Address:

City, State, Zip:

City, State, Zip:

Phone No.:

Phone No.:

Years Known:

Years Known:

How acquainted:

How acquainted:

Employment History (Start with most recent employer)

Company Name:

Street Address:

City: State/Region: Postal/Zip Code:

Phone No.: Supervisor Name:

Start Date: End Date: Start Wage: End Wage:

Position held: May we contact: Yes No

Responsibilities:

Reason for leaving:

Company Name:

Street Address:

City: State/Region: Postal/Zip Code:

Phone No.: Supervisor Name:

Start Date: End Date: Start Wage: End Wage:

Position held: May we contact: Yes No

Responsibilities:

Reason for leaving:

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 I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior education and employment history.

I understand that employment at American Leakless Company, LLC is “at will” which means that either I or the company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on an “at will” basis.

Signature: Date:

Contact this candidate