APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

Name

Date / Time

Date

Time

Address

Address Line 1

City

State

Zip Code

Email

Home Phone #

Mobile Phone #

Are you eligible to work in the U.S?

Yes
No

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

Yes
No

Have you ever been terminated from employment or asked to resign by an employer?

Yes
No

Can you work any shift?

Yes
No

Can you work overtime, including weekends?

Yes
No

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes
No

EMPLOYMENT DESIRED

Date you can start

Hourly rate/Salary desired

Position desired

Are you currently employed?

Yes
No

REFERRAL SOURCE

How did you hear about us?

Have you ever worked for this company before?

Yes
No

Are you related to anyone who currently works or previously worked for our company? Yes No If yes, who?

Do you know anyone who currently works or previously worked our company? Yes No If yes, who?

EDUCATION

High School

Name and location of school

Degree Received

Subjects studied/Major

work From Degree

College or University

Name and location of school

Degree Received

Subjects studied/Major

Trade, Business or Correspondence School

Name and location of school

Degree Received

Subjects studied/Major

EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employer 1

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

From

To

Employer Name

Telephone

Job Title

Address

Immediate supervisor and title

Summarize the nature of work performed and job responsibilities

Reason for leaving

REFERENCES

Give the names of three persons not related to you, whom you have known at least three (3) years.

Reference 1

Name

Address

Phone

Company

Email

Years Acquainted

Reference 2

Name

Address

Phone

Company

Email

Years Acquainted

Reference 3

Name

Address

Phone

Company

Email

Years Acquainted

Please read carefully before signing.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Protec to hire me. If I am hired, I understand that either Protec or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Protec has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Protec true and complete information on this application. No requested information has been concealed. I authorize Protec to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE BELOW.

Date

Signature

Clear Signature

Protect Equipment Resources

PERSONAL INFORMATION

EMPLOYMENT DESIRED

REFERRAL SOURCE

EDUCATION

High School

College or University

Trade, Business or Correspondence School

EMPLOYMENT HISTORY

Employer 1

REFERENCES

Reference 1

Reference 2

Reference 3

THIS APPLICATION IS VALID ONLY FOR 60 DAYS FROM THE DATE BELOW.

National Headquarters

Quick Links

Contact

Phone

Email