Job Application General Information Education Work Experience References and Consent Order Number First Name * Last Name * Address * City * State and Zip * Phone Number * Email Address Social Security Number * Date of Birth * Are you a Citizen? * YES NO If no, are you authorized to work in the U.S.? YES NO Have you ever been convicted of a crime? * YES NO If yes, please explain the number of convictions, nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committeed, sentence(s) imposed, and type(s) of rehabilitation As part of our hiring process, you will be required to take a pre-employment drug test. Do you agree to be tested? * YES NO As part of your employment at AHE-EC, Inc., you may be asked to have a background/fingerprint check through the TBI. Do you agree to participate in the background check if required? * YES NO Do you have a driver's license YES NO What is your means of transportation to work? * Driver's License Number * State of Issue * Expiration Date * Have you had any accidents in the past 3 year? * YES NO Have you had any moving violations in past 3 years? * YES NO If yes, how many? If yes, how many? Do you have any physical limitations that may preclude you from performing any work for which you are being considered? * YES NO Please describe Have you suffered any on the job injury in the past? * YES NO Please describe Have you ever served in the armed forces * YES NO If yes, please list your specialty, date entered and date discharged. Are you now a member of the national guard * YES NO If yes, please list your specialty and date entered Education Name of High School Number of Years Completed Address City State and Zip Name of College Number of Years Completed or Major and Degree Obtained Address City State and Zip Name of Trade School Number of Years Completed or Certification Obtained Address City State and Zip Work Experience Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give the name of the firm. Attach additional sheets if needed. Name of Employer May we contact this employer? YES NO Address City State and Zip Name of Supervisor Employment Dates Pay or Salary Job Title Reason for Leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Name of Employer May we contact this employer? YES NO Address City State and Zip Name of Supervisor Employment Dates Pay or Salary Job Title Reason for Leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. Name of Employer May we contact this employer? YES NO Address City State and Zip Name of Supervisor Employment Dates Pay or Salary Job Title Reason for Leaving List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company. References Please list two references other than relatives or previous employers Name * Phone Number * Please explain how you know the before mentioned reference. * Name * Phone Number * Please explain how you know the before mentioned reference. * Did you complete this application yourself? YES NO If not, who did? I 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 listed above to give you personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wage, be terminated at any time without prior notice. I 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 listed above to give you personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wage, be terminated at any time without prior notice. *
