Employment

Instructions: Please provide all information requested and answer all questions as fully as possible. Prospective employees will receive consideration without discrimination based on race, creed, color, sex, age, national origin or veteran status.

Personal

Full Name___________________________________________________________ Today’s Date______________

Street Address________________________________________________________Home Phone_______________

City, State, Zip_______________________________________________________ Work Phone_______________

Have you ever applied for employment with us before? _____________________Soc. Sec. No._______________

Are you 18 years of age or older? __________________________________________________________________

Position Desired_______________________________________________________Pay Expected______________

Are you legally eligible for employment in the United States? __________________ When can you start? ________

Can you work full time? ________________________________________________ Will you work overtime? ____

If not, what days/hours can you work? ______________________________________________________________

Were you ever employed or enrolled in school using a different name other than the name that is used on this application?

____________ If yes what name were you employed or enrolled under? (This is for verification purposes

only)_________________________________________________________________________________

List special training or skills beneficial to you in the position you are applying for____________________________

_____________________________________________________________________________________________

Some of the activities required of employees include; stooping, bending, and heavy lifting. One may have to endure

periods of excessive heat or cold, and standing in the same place for long periods of time.

Do you have any physical or medical conditions that would prevent you from safely performing the essential duties of the position that you are applying for? _______________ If yes, please indicate what may be done to accommodate your limitations _____________________________________________________________________Have you ever been convicted of a felony? (a conviction does not automatically bar you from employment; each case will be considered on its own merits) ___________ If yes, please explain______________________

APPLICATION FOR EMPLOYMENT

Military (complete this section only if you served in the U.S. Armed Forces)

Branch or Service______________________ Period of Active Duty (month & year) From________ To _________________

Rank at discharge__________________________ Date of final discharge________________________________________________

Describe your duties and any special training _______________________________________________________________________

Education:

Name of Elementary School _______________________________________________________ City & State___________________

Name of High School_____________________________________________________________ City & State __________________

No. of years attended____________ Did you graduate? ____________

Name of College or University ________________________________________________________________________________

No. of years attended ________ Did you graduate? _________ Major _________________ Degree____________________________

Other ____________________________________________________________________ City & State _______________________

No. of years attended ________ Did you graduate? _________ Major _________________ Degree ___________________________

Employment History:

(Give complete information for all jobs, full-time or part time, starting with your present or most recent position)

1) Company Name _________________________________________________________________ Phone ________________

City & State ______________________________________________ Employed (month & year) From _______To _______

Hourly Pay _______________ Name of Supervisor ___________________________________________________________

Reason for leaving _____________________________________________________________________________________

State your job title and describe your duties _________________________________________________________________

____________________________________________________________________________________________________

2) Company Name _________________________________________________________________ Phone ________________

City & State ______________________________________________ Employed (month & year) From _______To _______

Hourly Pay _______________ Name of Supervisor ___________________________________________________________

Reason for leaving _____________________________________________________________________________________

State your job title and describe your duties _________________________________________________________________

____________________________________________________________________________________________________

APPLICATION FOR EMPLOYMENT

3) Company Name _________________________________________________________________ Phone ________________

City & State ______________________________________________ Employed (month & year) From _______To _______

Hourly Pay _______________ Name of Supervisor ___________________________________________________________

Reason for leaving _____________________________________________________________________________________

State your job title and describe your duties _________________________________________________________________

____________________________________________________________________________________________________

4) Company Name _________________________________________________________________ Phone ________________

City & State ______________________________________________ Employed (month & year) From _______To _______

Hourly Pay _______________ Name of Supervisor ___________________________________________________________

Reason for leaving _____________________________________________________________________________________

State your job title and describe your duties _________________________________________________________________

____________________________________________________________________________________________________

Please add anything else about yourself or your employment history that might help us assess you for the position you are applying for.

___________________________________________________________________________________________________________

We may contact the employers listed above unless you indicate those you do not want us to contact. Do not contact.

Employer number _______________________ Reason _______________________________________________________________

Statement

The information provided in this Application for Employment is true, correct and complete. If I am hired, any misstatement or omission of fact on this application may result in my dismissal.

I understand that if I am hired, my first 6 months will be probationary period during which I or Electric City Conservatory may terminate my employment at any time, with or without cause, with or without notice.

I understand that if I am hired, my employment will not be for any definite period of time, even though I will be paid my wages on a bi-weekly basis.

No representative of Electric City Conservatory has made any promissory other statements to me which imply that I will be employed under any other terms than stated above.

If Electric City Conservatory decides to engage a background check, I authorize Electric City Conservatory to do so.

I understand that if I am hired, this Statement is part of the employment agreement between Electric City Conservatory and me, and will be binding on me.

Date______________________ Signature _______________________________________________________