Employment Opportunities, Corcoran Environmental Services ME

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Employment

EMPLOYMENT OPPORTUNITIES

All applicants are subject to drug and alcohol testing.

APPLICANT INFORMATION
Name:
Date of Birth:
Phone:
Email:
Position Desired:
Please list your residence addresses for the past 3 years (Street, City, State, Zip)
Current Address:
Length of Time (YR/MN):
Previous Address 1:
Length of Time (YR/MN):
Previous Address 2:
Length of Time (YR/MN):
Previous Address 3:
Length of Time (YR/MN):
Previous Address 4:
Length of Time (YR/MN):
Are you a US Citizen or have the right to work in the US? Yes No
If not a US Citizen, do you have proper green card? Yes No
Have you worked for this company before? Yes No
Who referred you?
Are you employed now?
Expected rate of pay:

EMPLOYMENT HISTORY
Please list your last 3 years of employment, starting with the most recent.
EMPLOYER #1
Employer Name:
Address:
Contact:
Employment dates (from/to):
Position Held:
Salary/wage:
Reason for leaving:
EMPLOYER #2
Employer Name:
Address:
Contact:
Employment dates (from/to):
Position Held:
Salary/wage:
Reason for leaving:
EMPLOYER #3
Employer Name:
Address:
Contact:
Employment dates (from/to):
Position Held:
Salary/wage:
Reason for leaving:
EMPLOYER #4
Employer Name:
Address:
Contact:
Employment dates (from/to):
Position Held:
Salary/wage:
Reason for leaving:

ADDITIONAL INFORMATION
Do you have a driver's license? Yes No
Do you have dependable transportation? Yes No
Highest level of education:
Available 1,2,3 shift?
Available for weekends?
Additional Education:
Do you have any convictions? If so, list dates, offense and circumstances/explanation below.
Conviction #1:
Conviction #2:
Conviction #3:
Additional Convictions:

REFERENCES
REFERENCE #1
Name:
Phone Number:
Relationship:
REFERENCE #2
Name:
Phone Number:
Relationship:
REFERENCE #3
Name:
Phone Number:
Relationship:

SIGNATURE
Please type your full name into the box below to sign this application. Applican't signature certifies that all information is true, factual and represents the actual information. Falsification of this document is grounds for dismissal.
Applicant Signature:

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