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Application for Employment

Last Name

First

M.I

Street Address

City

State/Province

ZIP / Postal Code

Phone

Email Address

Position applied for

Salary desired

Are you authorized to work in the U.S.?YesNo

Have you ever been convicted of a felony?YesNo

If Yes Explain

Have you previously applied for a position with The Trash Man?YesNo

Are you willing to work overtime?YesNo

When can you start?

WORK EXPERIENCE

Please list your work experience for the past five years beginning with your most recent job held.

Name

Street Address

City

State/Province

ZIP / Postal Code

Phone

Supervisor Name

Dates of Employment

From

Reason for leaving (be specific)

Were you subject to FMCSRs:YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Have you had any accidents in the past 5 years?Option 1Option 2

Have you had any moving violations in the past 5 years?YesNo

REFERENCES

Please list three professional references

Full Name

Relationship

Company Name

Street Address

City

State/Province

ZIP / Postal Code

Phone

Years Known

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The Trash Man is locally owned and operated in Terre Haute, Indiana. Serving you and your neighbors since 1999.

812-299-9009

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