Employment Application — Delta Waste Solutions

Position Information

Position Applied For *

Date Available

Desired Pay

Employment Type: Full-Time Part-Time

Authorized to work in the U.S.? Yes No

Previously worked for Delta Waste Solutions? Yes No

If yes, when?

Personal Information

Last Name *

First Name *

Middle Name

Street Address *

Apt / Unit #

City *

State *

Zip Code *

Phone (Primary) *

Phone (Alternate)

Email Address *

Social Security Number (XXX-XX-XXXX) *

Your SSN is collected solely for employment verification and background check purposes and will be kept strictly confidential.

Employment History

List your last three employers, starting with the most recent.

Employer 1 — Most Recent

Employer Name

Phone Number

Street Address

City

State

Zip

Job Title

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Reason for Leaving

Brief Description of Duties

May we contact this employer? Yes No

Employer 2

Employer Name

Phone Number

Street Address

City

State

Zip

Job Title

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Reason for Leaving

Brief Description of Duties

May we contact this employer? Yes No

Employer 3

Employer Name

Phone Number

Street Address

City

State

Zip

Job Title

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Reason for Leaving

Brief Description of Duties

May we contact this employer? Yes No

Education

High School

School Name

City, State

Years Attended

Did you graduate? Yes No GED

College / University (if applicable)

School Name

City, State

Years Attended

Degree / Major

Did you graduate? Yes No

Other Training / Certifications

Institution / Program

Certification / Skill Gained

Year Completed

Skills & Qualifications

List any software, tools, or office skills relevant to this position

Professional References

Please list three professional references. Do not list family members or former supervisors already listed above.

Reference 1

Full Name

Relationship to You

Company / Organization

Phone Number

Email Address

Years Known

Reference 2

Full Name

Relationship to You

Company / Organization

Phone Number

Email Address

Years Known

Reference 3

Full Name

Relationship to You

Company / Organization

Phone Number

Email Address

Years Known

Applicant Certification & Agreement

I certify that all information provided in this application is true and complete to the best of my knowledge. I understand that any false statement, misrepresentation, or omission of facts on this application may result in disqualification from employment or immediate termination if discovered after hiring. I authorize Delta Waste Solutions to contact former employers, references, and educational institutions to verify the information provided. I understand that employment with Delta Waste Solutions is at-will and may be terminated by either party at any time.

Full Name (Typed signature) *

Date *