Job Details
**EDUCATION**
Type of School School Name Course of Study Number of Years Attended **WORK EXPERIENCE**
Please list all previous employment, beginning with the most recent. Please account for all periods of time including any period of unemployment. Employer Name: Position / Title: Employer Location (City & State): Phone Number: Supervisors Name & Title: Dates Employed: Wages: $ $ Reason For Leaving: May We Contact:
Yes No Description of duties: Yes No If yes, please explain. **REFERENCES**
Please list the names of additional work-related references we may contact. Applicants with no prior work experience may list school or volunteer related references. Name Position Company Work Relationship
*(Supervisor, co-worker, etc)* Phone Number
Please list the names of personal references (not previous employers or relatives) who know you well that we may contact. Name Occupation Phone Number Years Known **AUTHORIZATION AND ACKNOWLEDGEMENTS**
I certify that all information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal regardless of the time elapsed before discovery.
I authorize investigation of all statements contained in this application. I also grant permission to contact all references listed above, and authorize them to release all information concerning my previous employment and any other pertinent information these references might have, personal or otherwise. I release The Duprey Service Company, LLC., its subsidiaries and current or former employers from all liability resulting from any information provided in connection with this application. Further I understand that I am not entitled to the information given in connection with my application for employment.
I understand and agree that the company may obtain a report concerning my prior employment, military record, education, character, general reputation, personal characteristics, criminal background, or mode of living. By signing below, I authorize the company to obtain such report.
I understand and agree that I may be asked to submit to pre-employment tests (including a drug test and preemployment physical) upon a conditional offer of employment. I understand and agree that if driving is a requirement of the position for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license.
I understand and agree that, if hired, my employment is at-will meaning for no definite period and may be terminated at any time and without prior notice. I understand that nothing in this application constitutes an employment contract. Further, I understand and agree that, if hired, any offer is contingent upon completing the Form I-9 and providing documentation of proof of employment eligibility.
If employed, I agree to conform to the rules and regulations of this organization.
Signature
*Please type your name to digitally sign this application.*