Apply Below - nanoCLEANdecon

Last Name

First Name

Middle Initial

Address

City

State

Zip Code

Cell Phone

Are you 18 years or older ?

Position Applying For?

Type of work desired

How Were you referred to the company ?

Date Available:

What Days / Times Are You Available For Work?

Salary Desired

Education - Highest Grade Completed

List Any Professional Designations

Other Special Knowledge, Skills or Qualifications

Computer Skills (Hardware/Software)

EMPLOYMENT HISTORY - List two (2) most recent positions. All information must be completed. You may attach a resume, but not in place of completing the Employment History.

Employed From:

Employed Until:

Employer Name:

Employer Address:

Supervisors Name:

Supervisor Phone:

Job Title:

Reason for Leaving:

Duties and Responsibilities:

Employer 2

Employed From:

Employed Until:

Employer Name:

Employer Address:

Supervisors Name:

Supervisor Phone:

Job Title:

Duties and Responsibilities:

Reason for Leaving:

Do you have your own vehicle ?

Yes

Do you have a valid Drivers License ?

Yes

May we contact your current employer for references?

Yes

AT- WILL EMPLOYMENT

It is my understanding that this employment application, or the granting of an oral interview, does not represent a contract of employment or a promise of future benefits by this organization. I understand and agree that, if hired, my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer. I also understand that this written statement supersedes any and all oral representations made by agents or representatives of this organization.

MASSACHUSETTS LAW

Under Massachusetts Law, it is unlawful in Massachusetts to require or administer a lie detector test as condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

CERTIFICATION OF TRUTH AND ACCURACY

I certify that the information in this application is true, complete and correct. I understand that false answers, statements or significant omissions made by me on this form shall be sufficient cause for denial of employment or discharge

I hereby acknowledge that I have read and agreed to the above statements.

Name:

Date:

If you are human, leave this field blank.