Employee Application Form for Express Scale Services

PO Box 748
Canyon, Texas, 79015
806.655.3033
steve@expressscale.com

We are an Equal Opportunity Employer and fully subscribe to the principles of Equal Employment Opportunity. Applicants and/or employees are considered for hire, promotions and job status, without regard to race, color, religion, creed, sex, marital status, national origin, age, physical or mental disability.

Please fill out this form.

Your Address*

City / State / Zip

Your phone number

Are you eligible to work in the United States?

Have you been convicted of or pleaded no contest to a felony in the last five years?

If yes, please explain:

Do you have a current driver's license? If so, select which Class.

Position / Availability

What position are you applying for?

Do you require any special accommodations?

What date are you available to start work?

Are you willing to work over time?

Are you willing to travel?

Are you willing to relocate?

Education

Name and location of school - Degree/Diploma

High School:

College Etc:

Skills and Qualifications: Licenses, Skills, Training

Employment History

Present or Last Position:
Employer:

Address:

Supervisor:

Phone:

Position Title:

How Long Have You Been Employed With This Company?

Responsibilities:

Salary:

Reason for Leaving:

Previous Position:

Employer:

Address:

Supervisor:

Phone:

Position Title:

How Long Had You Been Employed With This Company?

Responsibilities:

Salary:

Reason for Leaving:

May We Contact Your Present Employer?

References:

Name/Title Address Phone

Reference 1

Reference 2

Reference 3

Emergency Contact:

I certify that information contained in this application is true and complete. I understand that false information may be grounds of not hiring me or for immediate termindation of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

TYPE FULL NAME:

Date: