Millennium Recycling Application for Employment Date ______________ Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status. Millennium Recycling participates in E-Verify to confirm each new employee’s work authorization within the United States from their I-9 Form. (sp) Nuestra política es ofrecer igualdad de oportunidades laborales para todas las personas calificadas, sin distinción de raza, credo, color, creencia religiosa, sexo, edad, origen nacional, ascendencia, discapacidad física o mental, o estado de veterano. Millennium Recycling participa en E-Verify para confirmar la autorización de cada nuevo empleado de trabajo dentro de los Estados Unidos de su Formulario I-9. Application must be complete or will not be considered. (sp) La solicitud debe ser completa o no serán considerados. Last name ______________________________ First Name ____________________ Middle Name____________ Street Address ___________________________________________City _________________ State _______ ZIP _______ Telephone _______________________ Cell Phone ______________________ Social Security # ______________________ Position applied for _____________________________ How did you hear of this opening? ____________________________ When can you start? _____________________ Desired Wage $______________ Ever applied for employment here? Yes No When? __________ Prior employed by this company? Yes No Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis? (You may be required to provide documentation.) Yes No Are you 18 years or older? Yes No Do you speak any other languages? Yes No If yes, __________________________________________________ Are you looking for full-time employment? Yes No Shifts you are able to work Day Night Any Available for emergency or on-call? Yes No Have you ever been convicted of a felony? (Optional) Yes No If yes, please describe conditions. _______________________________________________________________________ ___________________________________________________________________________________________________ Education School Name and Location Year Major Degree High School ________________________________________ ______ ______ ______ College ___________________________________________ ______ ______ ______ College ___________________________________________ ______ ______ ______ Post-College _______________________________________ ______ ______ ______ Other Training ______________________________________ ______ ______ ______ In addition to your work history, are there other skills, equipment, qualifications, or experience that we should consider? __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Employment History (Start with most recent employer) Company Name ________________________________________________________________ Address ____________________________________ Telephone _________________________ Date Started ___________ Starting Wage ____________ Starting Position ________________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact? Yes No Responsibilities ___________________________________________________ Reason for leaving __________________________________________________________________________________ Company Name ________________________________________________________________ Address ________________________________________ Telephone _____________________ Date Started ____________ Starting Wage ____________ Starting Position _______________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact? Yes No Responsibilities ___________________________________________________ Reason for leaving __________________________________________________________________________________ Company Name ________________________________________________________________ Address ________________________________________ Telephone _____________________ Date Started ____________ Starting Wage ____________ Starting Position _______________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact? Yes No Responsibilities ___________________________________________________ Reason for leaving __________________________________________________________________________________ Company Name ________________________________________________________________ Address ________________________________________ Telephone _____________________ Date Started ____________ Starting Wage ____________ Starting Position _______________ Date Ended _____________ Ending Wage ____________ Ending Position ________________ Name of Supervisor ____________________________________ May we contact? Yes No Responsibilities ___________________________________________________ Reason for leaving __________________________________________________________________________________ Reference information: Name_______________________ Company______________________ Contact____________________ Years _______ Name_______________________ Company______________________ Contact____________________ Years _______ Name_______________________ Company______________________ Contact____________________ Years _______ **Attach additional information or resume if necessary. I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing. *(Sp)Certifico que los hechos expuestos en esta solicitud de empleo es verdadera y completa a lo mejor de mi conocimiento. Entiendo que si soy empleado, declaraciones falsas en esta solicitud será considerada causa suficiente de despido. Esta empresa se autoriza a hacer cualquier investigación de mis antecedentes de educación y empleo. Entiendo que el empleo en esta compañía es "a voluntad", lo que significa que yo o esta empresa puede rescindir la relación laboral en cualquier momento, con o sin previo aviso, y por cualquier motivo que no esté prohibido por ley. Todo el empleo se mantiene sobre esa base. Yo entiendo que ningún supervisor, gerente o ejecutivo de esta empresa, con excepción del presidente, tiene autoridad para modificar el anterior. Signature_______________________________________________ Date _________________