LEED Energy Services
  

APPLICATION FOR EMPLOYMENT

An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, nationalorigin, sex, age, disability, or any other status protected by laworregulation. It is our intention that all qualified applicants be givenequal opportunity and that selection decisions be based on job-relatedfactors.


Answereach question fully and accurately. No action can be takenon this application until you have answered all questions.Use blank paper if you do not have enough room on this application.PLEASE PRINT, except for signature on back of application.In reading and answering the following questions, be awarethat none of the questions are intended to imply illegalpreferences or discrimination based upon non-job-relatedinformation.
Job Applied forToday’s Date
Are you seeking: Full-time Part-time Temporaryemployment?
When could you start work?
Last Name
Middle Name
First Name
Telephone Number
Present Street Address
CityState
Zip Code

Are you 18 years of age or older? Yes No
(If you are hired, you may be required to submit proof of age.)
Social Security #
If hired, can you furnish proof you are eligibleto work in the U.S.? Yes No
Have you ever applied here before? Yes No
Ifyes, when?
Were you ever employed here? Yes No
If yes, when?
Have you ever been convictedof any law violation? (Include any plea of "guilty" or "no contest." Excludeminor traffic violations.)Yes No
If yes, givedetails

(A conviction will not necessarily disqualify an applicant foremployment.)
If employed, do you expect to be engaged in anyadditional business or employment outside of our job? Yes No
If yes, givedetails
For Driving Jobs Only:
Do you have a valid driver’slicense?Yes No
Driver’s License NumberClass of LicenseState Licensed In
Have you had your driver’slicense suspended or revoked in the last 3 years?Yes No
If yes, givedetails
List professional, trade,business or civic activities and offices held. (Exclude labororganizations and memberships which reveal race, color, religion, national origin,sex, age, disability or other protected status.)

LIST NAME AND ADDRESS OF SCHOOLS
Number of YearsCompleted
Diploma/Degree/Certificate
Subjects Studied
High School or GED:
College or University:
Vocational or Technical:
What skills or additionaltraining do you have that relate to the job for which youare applying?
What machines or equipmentcan you operate that relate to the job for which you areapplying?

List names of employers in consecutive orderwith present or last employer listed first. Account for allperiods of time including militaryservice and any periods of unemployment. if self-employed, give firm name andsupply business references.
Note: A job offer may becontingent upon acceptable references from current and former employers.
NAME OF EMPLOYERJOB TITLE AND DUTIES
ADDRESS
DATES OF EMPLOYMENT (MO/YR):

FROM TO
CITY, STATE, ZIP CODEPAY:
START $ FINAL $
SUPERVISOR(S) TELEPHONE
Reason For Leaving
NAME OF EMPLOYERJOB TITLE AND DUTIES
ADDRESS
DATES OF EMPLOYMENT (MO/YR):

FROM TO
CITY, STATE, ZIP CODEPAY:
START $ FINAL $
SUPERVISOR(S) TELEPHONE
Reason For Leaving
NAME OF EMPLOYERJOB TITLE AND DUTIES
ADDRESS
DATES OF EMPLOYMENT (MO/YR):

FROM TO
CITY, STATE, ZIP CODEPAY:
START $ FINAL $
SUPERVISOR(S) TELEPHONE
Reason For Leaving

Have you worked or attended school under anyother names? Yes No
If yes, givenames
Are you presently employed? Yes No
If yes, whom do you suggest wecontact?
Have you ever been fired from a job or askedto resign? Yes No
If yes, please explain:

Give three references, notrelatives or former employers.
Name AddressPhone


PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is trueand complete. I understand that any false information or omission maydisqualify me from further consideration for employment and may result in mydismissal if discovered at a later date.

I authorize the investigation of any or all statements contained in this application.I also authorize, whether listed or not, any person, school, currentemployer, past employers and organizations to provide relevant information andopinions that may be useful in making a hiring decision. I releasesuch persons and organizations from any legal liability in making such statements.

I understand I may be required to successfully pass a drug screening examination.I hereby consent to a pre- and/or post-employment drug screenas a condition of employment, if required.

I understand that if I am extended an offer of employment it may be conditionedupon my successfully passing a complete pre-employment physicalexamination. I consent to the release of any or all medical information as maybe deemed necessary to judge my capability to do the work for which Iam applying.

I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BYMANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOTCREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEEEMPLOYMENT FOR ANY DEFINITE PERIOD OFTIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITYTO ENTER INTO AN AGREEMENT OF EMPLOYMENT FORANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING,SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IFEMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILLOF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATEDAT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.


I have read, understand, and by clicking the submit buttonbelow consent to these statements.Yes No



Thisapplication for employment will remain active for a limitedtime. Ask the organization’srepresentative for details.