APPLICATION Please fill in all required fields. Job Application Personal Information First Name First Name Last Name Last Name Address Address State State Select A State Zip Code Zip Code Home Phone Home Phone Other Phone Other Phone Email Email Hours Available Hours Available Salery Requirement Salery Requirement Valid Drivers License and Transportation Available? Valid Drivers License and Transportation Available? Yes No Commercial License Type (if applicable) Commercial License Type (if applicable) Age 18 or Older? Age 18 or Older? Yes No Legally Able to Work in the United States? Legally Able to Work in the United States? Yes No Referred By Referred By Position(s) Applied For Position(s) Applied For Current or Most Recent Employment Title/Position Title/Position Employed From Employed From Employed To Employed To Company Company Reason For Leaving Reason For Leaving Address Address Beginning Salary Beginning Salary Ending Salary Ending Salary Phone Phone May We Call to Verify Information? May We Call to Verify Information? Yes No Summary of Duties Summary of Duties Previous Employment 1 Title/Position Title/Position Employed From: Employed From: Employed To: Employed To: Company Company Reason For Leaving: Reason For Leaving: Address Address Beginning Salary Beginning Salary Ending Salary Ending Salary Phone Phone May We Call to Verify Information May We Call to Verify Information Yes No Summary of Duties Summary of Duties Previous Employment 2 Title/Position Title/Position Employed From Employed From Employed To Employed To Company Company Reason For Leaving Reason For Leaving Address Address Beginning Salary Beginning Salary Ending Salary Ending Salary Phone Phone May We Call to Verify Information? May We Call to Verify Information? Yes No Summary of Duties Summary of Duties Education and Professional Development Professional Certifications Professional Certifications Member Of Member Of High School School Name School Name Address Address Dates Attended Dates Attended Major Major GPA GPA Detree/Diploma Awarded Detree/Diploma Awarded College 1 School Name School Name Address Address Dates Attended Dates Attended Major Major GPA GPA Degree/Diploma Awarded Degree/Diploma Awarded College 2 School Name School Name Address Address Dates Attended Dates Attended Major Major GPA GPA Degree/Diploma Awarded Degree/Diploma Awarded Other School Name School Name Address Address Dates Attended Dates Attended Major Major GPA GPA Degree/Diploma Awarded Degree/Diploma Awarded Additional Skills and Technical Training Skill or Training 1 Date Date Description of Training or Specialized Skill Description of Training or Specialized Skill Skill Level Skill Level Comments Comments Skill or Training 2 Date Date Description of Training or Specialized Skill Description of Training or Specialized Skill Skill Level Skill Level Comments Comments Skill or Training 3 Date Date Description of Training or Specialized Skill Description of Training or Specialized Skill Skill Level Skill Level Comments Comments Office Equipment Skills Typing/Keyboarding WPM Typing/Keyboarding WPM 10 key SPM 10-key SPM Other Other List Areas of Computer Proficiency List Areas of Computer Proficiency Acknowledgment and Certification I, the undersigned hereby certify and agree that all information provided herein represents my educational and professional experiences factually. I further understand that falsification of any information supplied may constitute termination at any time after an employment offer is made and accepted. In signing this application I acknowledge that: 1) CLM Equipment Company, Inc. is a private employer operating in Right To Work states, and that at any time, and for any reason deemed appropriate to CLM Equipment, my employment can be terminated without recourse to CLM Equipment outside those provisions enforced by State or Federal statute. 2) CLM Equipment Company does not enter into employment contracts nor make any offers of permanent employment. 3) CLM Equipment Company provides written policies to all employees at time of hire and reserves the right to modify those policies at any time. 4) Failure on the employee’s part to observe and perform in accordance with stated company policies can result in termination of employment. 5) CLM Equipment Company, Inc. is an Equal Opportunity Employer and does not discriminate on the basis of Age, Gender, Religion, Marital Status, Ethnic Background, or Political Affiliation. 6) In offering employment, CLM Equipment Company does not make any guarantees or permanent commitments in regard to work hours, compensation, or benefits, and reserves the right to modify these as required, without notice. I understand that if I accept an offer of employment that I will be required to produce additional personal information and documentation as is appropriate to my employment with CLM and as required for regulatory purposes, and may be required to submit to and successfully pass other screening or testing as appropriate to the position for which I am being hired and that this may include but may not be limited to: Drug Screening, Physical Examination, Motor Vehicle License Check, Employment Reference Verification, Educational/Training Verification, Criminal Background Check. Applicant Signature Applicant Signature Date Date References Reference 1 Name Name Company Company Title Title Length of Acquaintance Length of Acquaintance Phone Phone Reference 2 Name Name Company Company Title Title Length of Acquaintance Length of Acquaintance Phone Phone Reference 3 Name Name Company Company Title Title Length of Acquaintance Length of Acquaintance Phone Phone Choose the spade: Choose the printer: Add Widget Add Section
