Earth Waste & Metal Application For Employment

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New England Quality Service, Inc.
D.B. A. Earth Waste & Metal
49 Wales Street, Suite 1, Rutland, VT 05701

Provide only information that is requested. The provision of non-responsive information will result in disqualification of this application.

Name
First Last
Present Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Position Desired:
- Full Time
- Part TIme
Social Security Number
Please enter your number per this example: 555-55-5555
If you are under 18 years of age can you provide the required proof of your eligibility to work?
- Yes
- No
How were you referred?
Date able to start:
Date Format: MM slash DD slash YYYY
Salary desired:
Are you able to work all shifts?
- Yes
- No
If you answered "no" to the above, when are you UNABLE to work?
Are you a U.S. citizen or authorized to work legally in the United States?
- Yes
- No
Cities/States of Residence for the past 7 years:
Have you ever been employed here before?
- Yes
- No
Driving History
Do you have a valid driver's license?
- Yes
- No
Driver's license number:
State your driver's license number was issued in:
Class of license?
Has your driver's license been suspended or revoked in the last 3 years?
- Yes
- No
If your license has been suspended or revoked in the last 3 years, please furnish details.
How many motor vehicle accidents have you had in the past 5 years?
Education and Training
Please list all schools you attended from High School to present. Include trade and technical schools and any courses which may be relevant to your application. If more space is needed, please attach additional information to this form.
Name of high school attended:
Dates attended (from - to)
City & State
Course of Study/Degree
Name of trade/technical school attended:
Dates attended (from - to)
City & State
Course of Study/Degree
Name of college attended:
Dates attended (from - to)
City & State
Course of Study/Degree
Other Courses/Schooling (Including apprenticeship):
Dates attended (from - to)
City & State
Course of Study/Degree
Professional or Technical Licenses (for each, list state and date):
Please describe any job related skills or training not mentioned above:
Work History
LIST EMPLOYERS IN ORDER WITH PRESENT EMPLOYER FIRST. ACCOUNT FOR ALL PERIODS OF TIME. IF SELF EMPLOYED, GIVE FIRM NAME AND BUSINESS REFERENCES. WORK PERFORMED ON A VOLUNTEER BASIS MAY BE INCLUDED.
1. Employer
Address
Street Address City State ZIP Code
Start Date
Date Format: MM slash DD slash YYYY
Leave Date
Date Format: MM slash DD slash YYYY
Phone
Wage
Job Title
May we contact your supervisor?
- Yes
- No
Supervisor's Name
Supervisor's Phone
Description of Work:
Reason for Leaving:
2. Employer
Address
Street Address City State ZIP Code
Start Date
Date Format: MM slash DD slash YYYY
Leave Date
Date Format: MM slash DD slash YYYY
Phone
Wage
Job Title
May we contact your supervisor?
- Yes
- No
Supervisor's Name
Supervisor's Phone
Description of Work:
3. Employer
Address
Street Address City State ZIP Code
Start Date
Date Format: MM slash DD slash YYYY
Leave Date
Date Format: MM slash DD slash YYYY
Phone
Wage
Job Title
May we contact your supervisor?
- Yes
- No
Reason for Leaving:
Supervisor's Name
Supervisor's Phone
Description of Work:
Reason for Leaving:
Have you ever been fired from a job or asked to resign?
- Yes
- No
If YES, please explain:
Are you on a layoff and subject to recall?
- Yes
- No
* Are you known to schools/references (prior employers) by another name?
- Yes
- No
*Information sought solely to facilitate reference checks.
If YES, what name?
Military Service
Branch
Rank
Discharge Date
Date Format: MM slash DD slash YYYY
Training or type of work done in military service:
What machines or equipment can you operate that are related to the job for which you are applying?
References
Provide names of three persons not related to you, whom you have know at least one year.
1. Name
Address
Street Address City State ZIP Code
Business
Phone
Years Known
2. Name
Address
Street Address City State ZIP Code
Business
Phone
Years Known
3. Name
Address
Street Address City State ZIP Code
Business
Phone
Years Known
Read carefully and sign the statement below:
I certify that the information given above is true and complete and understand that misrepresentation and/or omission of requested information will result in the rejection of this application or my discharge if discovered after employment begins. I authorize the company to make inquiries regarding my history and character of prior employers, schools, government agencies or individuals and hereby release such entities and individuals from all liability in responding to inquiries in connection with my application and release the company from all liability with respect to such inquiries.
I understand that if employed, I will be an employee “at will” and may be terminated at any time, with or without cause, and with or without notice at the option of either the company or myself. If I am employed, I agree to abide by the companies policies, rules and procedures and any changes thereto. I further understand that no company representative other than the company’s C.E.O., and then only in writing and signed by the C.E.O., has authority to enter into any agreement for employment for any specific period of time or to make agreements contrary to the foregoing.
Applicant's Signature
By entering your name into this field you agree that it constitutes your legal, electronic signature.
Date
Date Format: MM slash DD slash YYYY
We are an Equal Opportunity Employer
It is the policy of New England Quality Services, Inc. to offer equal employment opportunity to all qualified persons regardless of race, color, religion, national origin, military status, sexual orientation, disability, gender, or age (in accordance with the law) or any other legally protected status.
Comments
This field is for validation purposes and should be left unchanged.

Driving History

Education and Training

Work History

Military Service

References

Read carefully and sign the statement below:

We are an Equal Opportunity Employer