Application Application for Employment with Total Sanitation Employment Application Personal Information Name * First Middle Middle Last * Last Street Address * Street Address 2 City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY ZIP * Position Sought * Seeking Part Time Full Time Phone Number * Email Address * Social Security Number * Date Available * Salary Desired * Are you over 18? * No Yes Are you legally eligible for employment in the United States? * No Yes (If offered employment, you will be required to provide documentation to verify eligibility.) Education Please indicate education or training which you believe qualifies you for the position you are seeking. Years of high school completed * 1 2 3 4 Which do you have? * Diploma GED Neither Professional License or Membership State of MN License Number * License Expiration Date * Endorsements * DOT Health Card Expiration Date * This application for employment is good for 30 days only. Consideration for employment after 30 days requires a new application. Please list other skills that are relevant to the position you are seeking: Record of Conviction During the last ten years, have you ever been convicted of a crime other than minor traffic offense? * No Yes (A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered). Please explain your conviction * Employment List last employer first, including U.S. Military Service. May we contact your present employer? * No Yes If any employment was under a different name, indicate name Work History Employer * Phone * Position * Street Address * Street Address 2 Employment Start * Employment End Salary Supervisor Department Duties Hours Status FT PT Reason for Leaving Section Buttons Additional Work History? No Yes Please upload a Word Doc or PDF with additional work history Explain any gaps in work history Have you ever been discharged or asked to resign from a job? * No Yes Please explain * Applicant's Certification and Agreement I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Total Sanitation Service, Inc. to verify their accuracy and to obtain reference information on my work performance. I hereby release Total Sanitation Service, Inc. from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment or anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause. Applicant Signature (Type to sign) Date *
