Employment Application Employment Application Name * Address * Phone * Email * Are you over the age of 18? * Yes No Date available to begin employment: * Position you are applying for: * Please check all that apply: I've filled out a previous application. I've previously worked here. Please explain your situation if you checked either box above. Best time to contact you? * Are you currently employed? * Yes No Are you a citizen of the United States? * Yes No Proof of citizenship or immigration status will be required upon employment. Do any of your friends/relatives work here? * Yes No If yes please include their name: Do you have a valid Driver's License? Yes No Emergency Contact: * Please include: Name, Address, Phone Number, Relationship Education Name and location of high school: Number of years completed at high school: Did you graduate high school? Yes No Name and location of college: Number of years completed at college: Degree completed: If applicable. Name and location of other education: Number of years completed at other education: Degree/Certification completed: Personal/Professional Reference #1 * List a non-relative who is familiar with your professional qualifications and actual work history. Must include: Name, Phone Number, and Occupation/Relationship Personal/Professional Reference #2 * List a non-relative who is familiar with your professional qualifications and actual work history. Must include: Name, Phone Number, and Occupation/Relationship Personal/Professional Reference #3 * List a non-relative who is familiar with your professional qualifications and actual work history. Must include: Name, Phone Number, and Occupation/Relationship Employment History Employer Phone Address Supervisor Job Title Duties Performed Start/End Dates Reason for leaving? May we contact your employer for a reference? Yes No Employer Phone Address Supervisor Job Title Duties Performed Start/End Dates Reason for leaving? May we contact your employer for a reference? Yes No Military Service Branch of Service Dates Rank at discharge: Type of discharge: If other than an Honorable Discharge, explain: Special skills, qualifications, and considerations. Machines or equipment qualified to operate: * Foreign language(s) if any: * Describe any specialized training, licenses, certifications, or job-related training that you feel would benefit this company: * Can you operate a computer? * Yes No Computer programs you can operate: Consent: * Yes I certify that my answers are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive or this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all ruled and regulations of the employer. I understand that after being offered a job. The commencement of my employment will be conditioned on the satisfactory results of an employment entrance examination which includes a drug screen and medical examination. I further understand that I will be subject to future medical exams and drug and alcohol screening when requested by Clean Energy Comfort. I understand this form does not indicate that there are any positions open at this time and does not in any way obligate the company. Submit If you are human, leave this field blank.