Employment Application

Applicant Information

Full Name:	Date:
Last	First	M.I.

Address:
Street Address	Apartment/Unit #

City	State	ZIP Code

Phone:	Email

Date Available:	Desired Salary:	$

Position Applied for:

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:

Do you have a valid driver’s license	YES	NO	If no, explain:

Education

High School:	Address:
From:	To:	Did you graduate?	YES	NO	Diploma::
College:	Address:
From:	To:	Did you graduate?	YES	NO	Degree:
Other:	Address:
From:	To:	Did you graduate?	YES	NO	Degree:

References

Please list three professional references.

Full Name:	Relationship:
Company:	Phone:
Address:
Full Name:	Relationship:
Company:	Phone:
Address:
Full Name:	Relationship:
Company:	Phone:
Address:

Previous Employment

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?	YES	NO
Company:	Phone:
Address:	Supervisor:
Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:
May we contact your previous supervisor for a reference?	YES	NO

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Military Service

Branch:	From:	To:

Rank at Discharge:	Type of Discharge:

If other than honorable, explain:

Special Skills & Qualifications

Summarize any special training skills, licenses and/or certificates that may qualify you. e.g. 40-hour HAZWOPER

Disclaimer and Signature

I certify that all information I have provided in order to apply for and secure work with EWMA is true, complete, and correct.

I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from EWMA’s service, whenever it is discovered.

I expressly authorize, without reservation, EWMA, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and any on-line public sources including social networks and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.

Notice to Employees and Applicants that Consumer Reports may be obtained. In compliance with Public Law 91-508 (Fair Credit Reporting Act), as amended by Public Law 104-208 (Consumer Credit Reporting Reform Act) and applicable state law, this notice is to inform you that consumer reports including Credit Bureau Reports, Motor Vehicle Reports, Drug Tests, Consumer Investigations, and medical information may be obtained in connection with your application for employment or current employment. If obtained, this consumer report may be used in making decisions concerning your application for employment and/or employment status with this company.

I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.

I understand that this application remains current for only 60 days. At the conclusion of that time, if I have not heard from EWMA and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and EWMA reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer.

I also understand that if I am hired, I will required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I have read and understand the above statements in its entirety, and acknowledge that any misrepresentation or omission of facts called for herein will, at EWMA’s option, result in the cancellation of consideration for employment, or dismissal from EWMA’s service if I have been employed.

Signature:	Date:

Thank you for your interest in our company and for taking the time to complete our employment application. Save completed form and email as an attachment to: staffing@ewma.com.

SPACE FOR ADDITIONAL EXPLANATION(S).