Employment Application I understand* All applicants agree to a background check and drug screen. Date Date Format: MM slash DD slash YYYY Name* First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Alabama Driver's License #Expiration Date Date Format: MM slash DD slash YYYY PhoneEmail PositionSalery DesiredDateYou Can Begin Date Format: MM slash DD slash YYYY Are you currently employed?YesNoEmployment History (LAST FOUR EMPLOYERS - LIST MOST RECENT FIRST)#1 Company Name#1 Position Held#1 Salary#1 From Date Date Format: MM slash DD slash YYYY #1 To Date Date Format: MM slash DD slash YYYY #1 Supervisor's Name First Last #2 Company Name#2 Position Held#2 Salary#2 From Date Date Format: MM slash DD slash YYYY #2 To Date Date Format: MM slash DD slash YYYY #2 Supervisor's Name First Last #3 Company Name#3 Position Held#3 Salary#3 From Date Date Format: MM slash DD slash YYYY #3 To Date Date Format: MM slash DD slash YYYY #3 Supervisor's Name First Last #4 Company Name#4 Position Held#4 Salary#4 From Date Date Format: MM slash DD slash YYYY #4 To Date Date Format: MM slash DD slash YYYY #4 Supervisor's Name First Last EducationAre you a US Military Veteran?YesNoDate of Entry Date Format: MM slash DD slash YYYY Date of Separation Date Format: MM slash DD slash YYYY US Military or Navel Service BranchRankName of High SchoolYears attended HS?Did you graduate HS?YesNoName of Trade SchoolYears Attended TS?Did you graduate TS?YesNoName of College/OtherYears attended college/other?Did you graduate college/other?YesNoList Special Training/SkillsReferencesLIST THREE (3) PEOPLE NOT RELATED TO YOU WHOM YOU’VE KNOWN FOR AT LEAST ONE YEARReference #1 Name First Last Reference #1 PhoneYears Known Reference #1Reference #2 Name First Last Reference #2 PhoneYears Known Reference #2Reference #3 Name First Last Reference #3 PhoneYears Known Reference #3AuthorizationI certify that the facts contained in this Application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this Application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that may have, personal or otherwise, and release Springer Equipment Company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of Springer Equipment Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Springer Equipment Company representative.eSignatureDate Date Format: MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.
