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Employment Application

Application for Employment

Instructions to Applicants

Name * First Last
Email *
Phone * - (###) - ### ####
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Social Security Number
Position Applied For
Department of Interest
If skilled craft, are you registered in an apprenticeship program?
What Year?
Grade Average?
Are you legally eligible for employment? (Proof of U.S. Citizenship or immigration will be required upon employment)
Have you ever been employed here before?
If Yes: Month and Year
If you are under 18, can you furnish a work permit?
Type of employment desired:
Date available for work? / MM / DD YYYY
Have you ever been convicted of a felony? (such conviction may be relevant if job-related, but does not bar you from employment)
If yes, please explain:
Driver's license number (if applicable)
State
Status of License
List any points or convictions on license:
Salary Desired Per Hour:
Or Annually:
Skills and Qualifications: (Summarize special skills and qualifications acquired from previous employment or other experiences that may qualify you to work with ECI.
EDUCATIONAL BACKGROUND
High School
Name and Location
Years Completed
Course of Study
Did you graduate?
College
Name and Location
Years Completed
Course of Study
Did you graduate?
Other
Name and Location
Years Completed
Course of Study
Did you graduate?
Employment History (list your last four (4) employers, assignments or type of work performed, starting with the most recent, including military experience.)
EMPLOYER #1
Name of Employer
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Your Job Title
Duties
Name and Position of Immediate Supervisor
Date Started / MM / DD YYYY
Date Left / MM / DD YYYY
Starting Salary
Final Salary
Reason for Leaving
May we contact for a reference?
EMPLOYER #2
Name of Employer First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Your Job Title
Duties
Name and Position of Immediate Supervisor
Date Started / MM / DD YYYY
Date Left / MM / DD YYYY
Starting Salary
Final Salary
Reason for Leaving
May we contact for a reference?
EMPLOYER #3
Name of Employer First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Your Job Title
Duties
Name and Position of Immediate Supervisor
Date Started / MM / DD YYYY
Date Left / MM / DD YYYY
Starting Salary
Final Salary
Reason for Leaving
May we contact for reference
EMPLOYER #4
Name of Employer First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Your Job Title
Duties
Name and Position of Immediate Supervisor
Date Started / MM / DD YYYY
Date Left / MM / DD YYYY
Starting Salary
Final Salary
Reason for Leaving
May we contact for a reference?
WORK REFRENCES (Please do not list relatives)
Reference # 1 Name First Last
Phone - (###) - ### ####
Years Known
REFERENCE #2 Name First Last
Phone - (###) - ### ####
Years Known
REFERENCE #3 Name First Last
Phone - (###) - ### ####
Years Known
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the Employer's services if I have been employed. Furthermore, I understand that just as I am free to resign at any time, with or without cause and without prior notice. I understand that now representative of the Employer has the authority to make assurances to the contrary. I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information. * First Last
I certify that the information contained in this application is correct. I understand that the misrepresentation or omission of information called for in this application is cause for refusal to hire or, if hired, is cause for immediate dismissal. I authorize the investigation of all statements contained in this application and authorize any of the persons or organizations referenced in this application to furnish ECl any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and re lease all persons or organizations from any and all liability or damages that may result from their furnishing such information to ECl. Further, I understand and agree that my employment is "at will" and for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time with or without notice at the option of either ECl or myself. Further, I understand that no officer, agent, representative, or employee of ECl, other than the President, has any authority to enter into any agreement for employment for any specified period of time or to make any agreement contrary to that contained in the previous sentence. In the event I become an employee of ECl, I agree to comply with all rules and regulations and understand that I may be terminated or disciplined for any violations. I further understand that the rules and regulations may be changed, interpreted, withdrawn or added to by ECl at any time at its sole option and without any prior notice. Any offer of employment tendered to the applicant by ECl is conditional and is subject to a successful completion of a drug test, background check and, if relevant, motor vehicle test at employer's discretion.
Can you perform all essential functions of the position for which you are applying? * Yes No
Your NAME is your signature * First Last

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Application for Employment

Application for Employment

EDUCATIONAL BACKGROUND

High School

College

Other

Employment History (list your last four (4) employers, assignments or type of work performed, starting with the most recent, including military experience.)

EMPLOYER #1

EMPLOYER #2

EMPLOYER #3

EMPLOYER #4

WORK REFRENCES (Please do not list relatives)