Employment Application - Southern Fluid Systems

APPLICATION FOR EMPLOYMENT

Complete ALL fields.

First Name *

Middle Name

Last Name *

Preferred Name

Street Address *

Apartment, suite, etc

City

State

ZIP Code

Phone Number *

Email Address *

Emergency Contact *

Do you understand the requirements of the Position you have applied for?YesNo

Can you perform the physical requirements with or without reasonable accommodation?YesNo

Will you work overtime if needed?YesNo

Do you currently have any relatives working for the Company?YesNo

If so, please list name(s):0 / 180

Position Applied for:

Pay Expected

Only those U.S. Citizens or Aliens who have a legal right to work in the United States are eligible for employment. Can you, upon employment, provide documentation verifying your legal right to work in the U.S. and your identity?YesNo

Education

High School Name and Location *

Did you graduate from High School? *YesNo

Type of High School Degree Awarded

High School Major Area of Study

If you did not graduate from High School what was the last year of school you completed?

College Name and Location

Did you graduate from college?YesNo

Type of College Degree Awarded

College Major Area of Study

Name & Location of Other School(s) Attended

List any other Education, Certifications, or Trade Skills that you have which relate to this job:

Are you 18 years of age or older? *YesNo

Employment History

Please provide accurate, complete full-time and part-time employment history for your last three positions. Start with your most recent employer.

Employer #1

Company Name *

Street Address *

City

State

ZIP Code

Phone *

Supervisor's Name *

Your Title *

May we contact this Employer? *YesNo

Start Date *

End Date *

Reason for Leaving *

Employer #2

Company Name

Street Address

City

State/Province

ZIP Code

Phone

Supervisor's Name

Your Title

May we contact this Employer?YesNo

Start Date

End Date

Reason for Leaving

Employer #3

Company Name

Street Address

City

State/Province

ZIP Code

Phone

Supervisor's Name

Your Title

May we contact this Employer?YesNo

Start Date

End Date

Reason for Leaving

Please explain any gaps in employment:

Important - Read Carefully Before Signing

I certify that the information provided in this Application for Employment is true, correct and complete. If employed, any misstatement or omission of material fact on this application will result in my immediate dismissal. I authorize all persons, schools, companies, corporations, credit bureaus, government agencies, or any other party to release information concerning my background which may include, but is not limited to, criminal, credit, driver's records, so long as not prohibited by law and the requests are job related.

I further agree to submit to alcohol and/or drug screening tests, if requested of me, at any time prior to (only drug screens will be administered pre-employment), or during my employment in accordance with applicable law, and I further understand and consent to the results of said tests being communicated to the Company. I further understand that no one, other than the President of the Company, in writing, has the authority to enter into an employment agreement with me that differs from that which is outlined here, and that if I should become employed by the Company that the employment relationship is "at will" and can be terminated by either party without cause.

I further understand that this application for employment will remain "active" for thirty (30) days from today's date. If I still desire a position with the Company, it will be my responsibility to fill out a new application and file it with the Company after that period expires.

Signature of Application: *

Date *