Employment Application Step 1 of 6 - Position Desired & Personal Information 16% Title of position for which you are applying:(Required) Date available to begin employment:(Required) MM slash DD slash YYYY Desired Wage/Salary:(Required) Desired Hours:(Required) Any hours available Weekdays only Rotating shift Part-time Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Are you a citizen of the U.S.?(Required) Yes No Do you have any special needs that may necessitate accommodations in the application/interview process?(Required) Yes No If yes, please describe the type of accommodation requested. EducationInclude high school and/or institution issuing GED and any additional education/courses takes. Do not list date of attendance for high school. Please list your most recent education first.Education Name of School: Address of School: Degree/Diploma Received: Major/Minor: Dates of Attendance: Actions Edit Delete There are no Schools. Add School Maximum number of schools reached. List /describe any other training and/or experience relevant to the position for which you are applying: Work/Volunteer ExperienceList all work and volunteer experience – most recent to be listed first. Previous Employers Employer Address Actions Edit Delete There are no Employers. Add Employer Maximum number of employers reached. LicensureList current licenses, regulations or certificates relevant to the position for which you are applying.Licenses License Number Issued By: Issue Date Expiration Actions Edit Delete There are no Licenses. Add License Maximum number of licenses reached. ReferencesThese should be people in a position to discuss your qualifications for the position you seek. Include especially managers, directors or heads of departments under whom you have worked. Indicate any who are related to you. Pope/Douglas Solid Waste Management reserves the right to contact all prior employers, educational institutions or institutions where you have volunteered in addition to references listed below.References Name Phone Address Actions Edit Delete There are no References. Add Reference Maximum number of references reached. Criminal Background InformationPope/Douglas Solid Waste Management will request information regarding criminal history in the event that you become a finalist for the position for which you are applying. For certain positions, criminal background information will be requested during the application stage. Further, Pope/Douglas Solid Waste Management may conduct a criminal background check on individuals upon making a contingent job offer. Please refer to the job description for this position to determine if such a check will be conducted. If the job description states that a criminal check will be conducted, no offer of employment shall become final until receipt of the results of the criminal background check from the BCA or other agency, the content of which is acceptable to Pope/Douglas Solid Waste Management, and formal approval by the appointment authority.I understand the above.(Required) Yes Veteran's StatusAre you an honorably discharged veteran of the armed forces of the United States or are you otherwise eligible to claim Veteran’s Preference Points? Yes No Do you wish to claim Veteran’s Preference Points? Yes No If you are a disabled veteran and wish to claim additional points, please check here: Yes Applicants must supply a copy of their DD214, which must show years of service and type of discharge. Disabled veterans must also supply form FL21-802, or an equivalent letter from a service retirement board. Each eligible spouse of a disabled or deceased veteran applying for preference points must supply his or her marriage certificate, the Veteran’s DD214 and FL21- 802 or death certificate.Prior EmploymentHave you ever been discharged or forced to resign from prior employment, other than in relation to a human rights charge or lawsuit in which you were the claimant/plaintiff? Yes No If so identify the employer and describe the circumstances: Certification, Acknowledgement & ReleaseResume or Cover Letter (optional) Drop files here or Select files Accepted file types: jpg, png, pdf, , Max. file size: 300 MB, Max. files: 3. I certify that the answers I have given on this application are true and correct to the best of my knowledge. I understand that any false or misleading information provided, or any omission or concealment of facts, will disqualify me from consideration of employment, and constitutes grounds for my immediate dismissal should I be employed by Pope/Douglas Solid Waste Management. I understand, acknowledge and agree that no offer of employment is valid or binding until formal approval by the Pope/Douglas Solid Waste Management Board of Directors and that until such approval, that Pope/Douglas Solid Waste Management shall not be liable for any reliance on any oral or written offers of employment made to me. In connection with this application, I hereby authorize any and all former employers, organizations where I have volunteered (“volunteer organizations”) and references named in the application, or any agent of such a former employer or volunteer organization, to release to Pope/Douglas Solid Waste Management and it’s agents any and all information regarding my job performance and fitness/qualifications to perform the position I am presently seeking and any other employment or related information, both public and private, in the possession. I understand that Pope/Douglas Solid Waste Management will use this information to determine my fitness/qualifications for the position I am seeking. This authorization expires one year from the date of my signature below. I hereby release Pope/Douglas Solid Waste Management and all former employers, volunteer and references listed herein and any and all agents’ action on behalf of said Pope/Douglas Solid Waste Management, former employers, volunteer organizations or references, for any and all liability of whatever nature by reason of requesting or providing such information.(Required) Date MM slash DD slash YYYY CAPTCHA Δ
