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Application for Employment

Please read carefully and fill out form completely.(If unaplicable N/A is required). Provide all information requested. When completed, submit it by pressing “submit” button at the bottom of form. Your completed application form will be maintained in our active files for fifteen (15) days from date of application. You may submit a new application at any time.

Name *

Phone *

Email *

Address *

Referred by

Starting with present or most recent employment, list all employers. Include self-employment and summer and part-time jobs.

Company

Position

Wage

Dates Employed

Company

Position

Wage

Dates Employed

Company

Position

Wage

Dates Employed

List two past supervisors and one other person who are not related to you who have knowledge of your qualifications for the position for which you are applying."

Supervisor 1

Company

Phone

Supervisor 2

Company

Phone

Other Reference

Company

Phone

Will Visa or immigration status prevent lawful employment?

Yes No

Do you hold a current asbestos certification?

Yes No

Do you have a current physical respirator card?

Yes No

Would you be willing to work other than the day shift?

Yes No

Yes No May we contact your present employer?

Yes No

Have you previously been employed by Eagle Environmental?

Yes No

Do you have any relative(s) currently employed by Eagle Environmental?

Yes No

Were you referred by an Eagle Environmental employee?

Yes No

Have you been convicted of any crimes other than minor traffic violations during the past seven years?

Yes No

Do you have any disabilities or health problems that may affect your ability to perform the job applied for, or which you would like the Company to consider in determining your job placement?

Yes No

Will you consent to medical/respiratory exam, drug screen and background check (if required by Eagle)?

Yes No