Employment Application – Now Hiring – Energy Management Corporation

Employment Application

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Please be as specific as possible.

(* indicates required fields)

*Name:
Address:
City:
State:
Zipcode:
*Phone Number:
Alternate Phone Number:
*Email Address:
*Position for which you are applying:
Date available to work:
Expected Salary:
Are you legally eligible to work in the US?	Yes No
Are you presently employed?	Yes No
Preferred time	Part Time Full Time
Factors that effect work schedule	Other Employment School Other business or personal commitments
How did you hear about this position?
Have you ever applied for a position with our company?	Yes No
Do you have any relatives employed by our company?	Yes No
Employment Record (Most Recent) Date employed: Employer: Your Title: Reasons for Leaving: Salary:	Job Description:
Employment Record Date employed: Employer: Your Title: Reasons for Leaving: Salary:	Job Description:
Employment Record Date employed: Employer: Your Title: Reasons for Leaving: Salary:	Job Description:
Education Name of School: Major/Focus: Minor: Graduated?:	Highest level reached
Military Experience: Learned Skill: Learned Skill:	Yes No
Highlight any special skills or reasons why you should be considered for the position:
Reference Name # of years known Relationship Telephone
Reference Name # of years known Relationship Telephone
Reference Name # of years known Relationship Telephone
May we contact your present employer for a reference?	Yes No
Optional EEO Compliance: Race/Ethnicity
Optional EEO Compliance: Veteran Status	Special Disabled Veteran Vietnam Era Veteran
Optional EEO Compliance: Sex	Male Female
Driving Information: Drives License No Expiration Date State
Has your license ever been suspended or revoked?	Yes No
If your license has been suspended or revoked, why?
Have you ever been convicted of a crime other than a minor traffic violation?	Yes No
If yes, please give a brief explanation, dates, and disposition
Would you be willing to take a drug/alcohol-screening exam before and/or after employment as a condition of employment?	Yes No
Questions:
Electronic Signature (A signature here is an agreement to the note below)
Date
Please Read: All information provided by me is true and correct to the best of my knowledge. I understand omissions or misrepresentations may result in rejection of my application or, if employed, may result in subsequent dismissal. I understand and agree that background inquiries may be requested by you or on your behalf that will seek information as to my character, work habits, including oral assessments of my job performance, experiences and abilities, along with reasons for termination of past employment. Furthermore, I understand and agree that you may request information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background, and other past experiences. I acknowledge that a telephonic facsimile or copy of this release shall be as valid as the original. This release is valid for all federal, state, county and local agencies and authorities. I understand this is a preliminary application and not a contract to employ me. Furthermore, in the event I am employed, my employment shall be completely voluntary and may be terminated at will at any time by either myself or the company. I understand that no one other than the company president has authority to enter into any employment agreement to the contrary. I agree to take a job-related physical examination or a drug/alcohol test when requested as a condition of employment. I agree to comply with all rules of the company as a condition of employment. In the event the company advances me money or other things of value, I agree to repay the company and also that any amount still owing may be deducted from my final paycheck.

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This information will only be used by Energy Management Corporation. Thank you.