Application for Employment

Geofill Material Technologies LLC is an equal opportunity employer. Qualified applicants will be considered for vacancies without regard to race, color, religion, sex, national origin, age handicap, or disability (physical and mental), Vietnam era or disabled veteran status. Information received in response to the questions on this application will not be used to discriminate against any applicant.

PERSONAL INFORMATION:

Please tell us about yourself.

First Name

Middle Name

Last Name

Email Address

If no email use N/A

Are you at least 18 years of age?

ID Type

ID / License Number

ID / License State

ID / License Expiration

mm/dd/yyyy

List any moving traffic violations incurred in the past 3 years:

SSN

Date of Birth

mm/dd/yyyy

Area Code & Telephone Number

Mailing Address

Years at Present Address

If less than 2 years at the present address, give previous address:

Are you legally eligible for employment in the US?

Have you ever been convicted of, or are you serving probation for, any offense, excluding minor traffic violations?

EDUCATION:

Tell us about your education and skills that will pertain to the work desired.

High School Name

High School City and State

High School or GED Graduate?

College Name

College Degree Acquired

If you have attended more than one college, list your last and/or highest Degree completed, or the Degree that pertains to this application.

College City and State

College Graduate

Trade School Name

Trade School City and State

Trade School Graduate

Describe any specialized training qualifications and/or skills acquired from employment or other experience:

EMERGENCY CONTACT INFORMATION:

Who should we contact in case of an Emergency?

In case of emergency notify:

Emergency Contact Phone

JOB INFORMATION:

Tell us about the work you are seeking.

Are you a previous employee of Geofill, Geotech, MK1, or Flashfill Services?

Position Desired

Type of Employment you want:

Presently Employed?

Will you work Overtime?

Will you work Weekends?

Minimum salary requirement

Date available for work

mm/dd/yyyy

How did you hear about this job?

WORK HISTORY:

Please give accurate, complete full-time and part-time employment records for your last four (4) jobs or the equivalent of ten (10) years of experience. Start with your present or most recent employer.

Do You Have Any Previous Work Experience?

Employer 1 Name

Phone

Mailing Address

Start Date

mm/dd/yyyy

End Date

mm/dd/yyyy

Supervisor's Name

Beginning Pay

Ending Pay

Job Title

Work Description

Please describe your job duties and responsibilities.

Reason for Leaving

Is this your current Employer?

May we contact your Employer?

Additional Work Experience?

MILITARY EXPERIENCE:

Have you served in the Military?

WORK REFERENCES:

List job references (exclude relatives) who have personal knowledge of your training, experience and capabilities.

Reference 1 Name

Email Address

Phone

Reference 2 Name

Email Address

Phone

Reference 3 Name

Email Address

Phone

SUBMISSION:

By printing your full name and submitting this application, you verify that all of the information provided on this application and in resumes and exhibits is true, correct, and complete. I have accounted for all of my work experience, training, and other information requested on this application. I understand that any false, misleading, incomplete, or omitted information on this application, or on resumes and exhibits will result in rejection of my application or termination of employment, whenever discovered. I understand that this application does not constitute an employment offer or contract with Geofill Material Technologies. If employed, I agree to comply with Geofill Material Technologies policies, rules, and procedures. If hired, my employment will be for an indefinite time period and I may resign or be terminated at any time without notice or requirement of cause. If considered for employment, I authorize Geofill Material Technologies and its agents to make any inquires about the information contained on this application, resumes, and exhibits, and to investigate my suitability for employment. I agree to furnish additional information as requested by Geofill Material Technologies. I release Geofill Material Technologies, its agents, and all other parties from any claims, liabilities, and damages resulting from obtaining or furnishing information about me. I understand that before or after receiving an employment offer I may be asked to submit to testing for the current illegal use of drugs and/or controlled substances. The reason for such testing is that Geofill Material Technologies endeavors to operate its business, in a safe manner for employees, customers, and visitors. The results of such testing will be communicated to Geofill Material Technologies and used to determine my suitability for employment. I understand that if I refuse to consent to testing, or test positive for the current illegal use of drugs or controlled substances, I will not be further considered for employment. I understand that if I receive a conditional offer of employment, I may be asked to take a job-related medical examination, the results of which will be communicated to Geofill Material Technologies and used to determine my suitability for employment. I understand that if I refuse to take such a medical examination I will not be further considered for employment. I understand that upon hiring I will be required to complete a Federal I-9 form and provide documents verifying my right to work in the United States.

Printed Full Name for Signature

SUPPORTING DOCUMENT UPLOAD:

Please upload any supporting documents such as; Resume, Cover Letter, Certificate Completions, Certifications, or Transcripts, etc..

Send me a copy of my responses

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