Applicant Information

First & Last Name

Address

City, State, Zip Code

Phone Number

Email

Date of Application

Employment Position

Position Applying For: General Laborer (Full Time)

How did you hear about this position?

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Salary Desired

Personal Information

Have you applied to or worked for Farmer's Septic Service, Inc. before?
YesNo

If yes, when?

Do you have any friends, relatives, or acquaintances working for Farmer's Septic Service, Inc.?

YesNo

If yes, state their name and your relationship:

Are you 18 years old or older?
YesNo

Are you a U.S. Citizen or approved to work in the United States?
YesNo

What document can you provide as proof of citizenship or legal status?

Will you consent to a mandatory controlled substance test?
YesNo

Do you have any condition which would require job accommodations?
YesNo

If yes, please describe accommodations required below:

Have you ever been convicted of a criminal offense (felony or misdemeanor)?
YesNo

If yes, please state the nature of the crime(s), when and where convicted, and disposition of the case:

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however, be considered.

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

Note: Farmer's Septic Service, Inc. complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.

Education and Training

High School

Name

Location (City, State)

Year Graduated

Degree Earned

College/University

Name

Location (City, State)

Year Graduated

Degree Earned

Vocational School/Specialized Training

Name

Location (City, State)

Year Graduated

Degree Earned

Military

Are you a member of the Armed Services?
YesNo

What branch of the military did you enlist?

What was your military rank when discharged?

How many years did you serve in the military?

What military skills do you possess that would be an asset for this position?

Previous Employment

Employer Name

Job Title

Supervisor Name

Employer Address

City, State, Zip Code

Employer Telephone

Dates Employed

Reason for Leaving

Previous Employment Continued

Employer Name

Job Title

Supervisor Name

Employer Address

City, State, Zip Code

Employer Telephone

Dates Employed

Reason for Leaving

Previous Employment Continued

Employer Name

Job Title

Supervisor Name

Employer Address

City, State, Zip Code

Employer Telephone

Dates Employed

Reason for Leaving

References

Please provide a personal and professional reference below

Personal Reference Name

Contact Information

Professional Reference Name

Contact Information

Additional Information

I, the undersigned, certify that my answers are true and host to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my termination.

Type full name to acknowledge understanding and agreement of the statement above:

Emergency Contact Information

Emergency Contact 1

Contact Phone Number

Emergency Contact 2

Contact Phone Number

At-Will Employment

The relationship between you and the Farmer's Septic Service, Inc. is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Farmer's Septic Service, Inc. No representative of Farmer's Septic Service, Inc. has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President.

Type full name to acknowledge understanding and agreement of the statement above:

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