Employment Application

Applicant information

Last name *

First name *

Middle initial

Position applied for *

Street address

Apartment / unit #

City

State

ZIP code

Phone *

Email *

Date available

Desired salary ($)

Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, explain

We don't ask for your Social Security number online. If we move forward with your application, we will ask for it in person.

Education

High school

Address

From

Did you graduate?

Yes No

Diploma

College

Address

From

Did you graduate?

Yes No

Degree

Other

School or training

Address

From

Did you graduate?

Yes No

Degree or certificate

References

Please list three professional references.

Reference 1

Full name

Relationship

Company

Phone

Address

Reference 2

Full name

Relationship

Company

Phone

Address

Reference 3

Full name

Relationship

Company

Phone

Address

Previous employment

Previous employer 1

Company

Phone

Address

Supervisor

Job title

Starting salary ($)

Ending salary ($)

From

Reason for leaving

Responsibilities

May we contact your previous supervisor for a reference?

Yes No

Previous employer 2

Company

Phone

Address

Supervisor

Job title

Starting salary ($)

Ending salary ($)

From

Reason for leaving

Responsibilities

May we contact your previous supervisor for a reference?

Yes No

Previous employer 3

Company

Phone

Address

Supervisor

Job title

Starting salary ($)

Ending salary ($)

From

Reason for leaving

Responsibilities

May we contact your previous supervisor for a reference?

Yes No

Military service

Branch

From

Rank at discharge

Type of discharge

If other than honorable, explain

Disclaimer and signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I have read the statement above and agree *

Signature (type your full name) *

Questions about the application? Call (479) 619-8226.

Thank you, your application was sent.

Our office will review it and contact you. If you have questions, call (479) 619-8226.

Join the State Line Septic team.

High school

College

Other

Reference 1

Reference 2

Reference 3

Previous employer 1

Previous employer 2

Previous employer 3

Thank you, your application was sent.