Employment Application | North State Enviromental

- Step 1 of 4

Applicant Information

Name *

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Date Available

Position Applied For

Are you a Citizen of the United States?

Are you authorized to work in the U.S?

Have you ever worked for this company?

When?

NORTHSTATE ENVIRONMENTAL, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

Education

High School

Address

Address Line 1

Address Line 2

City

State

Zip Code

Dates Attended (From - To)

Did you graduate High School?

College

Address

Address Line 1

Address Line 2

City

State

Zip Code

Dates Attended (From - To)

Did you graduate college?

Degree

Other Education

Address

Address Line 1

Address Line 2

City

State

Zip Code

Dates Attended (From - To)

Did you graduate?

References

Please provide three professional references.

Name - Reference 1

First

Last

Relationship

Company

Phone

Name - Reference 2

First

Last

Relationship

Company

Phone

Name - Reference 3

First

Last

Relationship

Company

Phone

Previous Employment

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor

Job Title

Responsibilities

Dates of Employment (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor

Job Title

Responsibilities

Dates of Employment (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Company

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Supervisor

Job Title

Responsibilities

Dates of Employment (From - To)

Reason for Leaving

May we contact your previous supervisor for a reference?

Military Service

Have you served in the Military?

Branch

Dates Served (From - To)

Rank at Discharge

Type of Discharge

If other than honorable, explain

Resume Upload

Click or drag files to this area to upload. You can upload up to 3 files.

Please submit a copy of your resume by uploading it here.

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Electronic Signature

By checking this box and typing my name below, I am electronically signing my application.

EQUAL OPPORTUNITY EMPLOYER QUESTIONNAIRE

In order to comply with United State Government Equal Opportunity requirements, all applicants for employment are requested to complete this form. This form is not part of the application packet. Data collected will be used for statistical reporting purposes and to measure the effectiveness of recruitment efforts and selection procedures. This information is requested on a voluntary basis, will be kept confidential, and is not available to hiring authorities. North State Environmental, Inc. is an equal opportunity employer. In accordance with applicable laws and regulations, North State Environmental, Inc. does not discriminate on the basis of disability or other prohibited criteria. If you believe you have been treated unfairly or discriminated against on the basis of race, color, national origin, gender, age, religion, political affiliation, sexual orientation, or disability, please contact the Human Resources Manager at (336) 725-2010, ext. 1020 Thank you for completing an application for this position and in your decision to select North State Environmental, Inc. as a possible employer. If you need clarification of information on this form please contact the Human Resources Manager at (336) 725-2010, ext. 1020.

EEO Questionaire

(Refusal to complete this form will have no effect whatsoever on consideration for employment.)

Date

Gender:

Male
Female

Name

First

Middle

Last

Age

Position Applied For:

How did you learn about the position?

(Newspaper, Internet, Current Employee)

Race / Ethnic Data

Hispanic or Latino - A person of Cuban, Mexican, Purto Rican, South or Central American, or other Spanish culture or origin regardless of race.
White or Caucasian (not Hispanic or Latino) - A person having origins of any of the original peoples of Europe, the Middle East, or North Africa
African American or Black (not Hispanic or Latino) - A Person having origins in any of the black racial groups of Africa
Asian or Pacific Islander (not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Phillipine Islands, Thailand, and Vietnam.
Other Pacific Islander or Native Hawaiian (not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
Two or More Races (not Hispanic or Latino) - All persons who identify with more than one of the above six races.
I do not wish to enter voluntary self-identification EEOC information.

Do you consider yourself a person with a disability?

Person with a disability: Any person who has a physical or mental impairment that substantially limits one or more major life activities and that affects employability, has a record of having such impairment, or is regarded as having such impairment.

National Origin:

Are you a veteran of the United States Armed Forces?

If yes, please describe your status and the branch in which you served.

I understand that this information will be kept confidential and used only in accordance with applicable Federal laws and regulations.

By checking this box and typing my name below, I am electronically signing this questionnaire.

Signature

Date

North State Environmental Drug and Alcohol Use Policy

North State Environmental, Inc. strives to provide a drug-free, healthful, and safe workplace. All employees are expected to report to work in a mental and physical condition which enables you to perform your job in a satisfactory manner.

While on North State Environmental, Inc.'s premises or while conducting business-related activities off North State Environmental, Inc.'s premises, you may not use, possess, distribute, sell, or be under the influence of alcohol or illegal drugs. We permit the legal use of prescribed drugs on the job only to the extent they do not impair your ability to perform the essential functions of your job effectively and safely without endangering others.

If you are prescribed a drug that may affect your ability to perform your job, you must notify your supervisor and provide a medical document to explain the effects of the drug, prior to returning to work.

Violation of this policy will lead to disciplinary action, up to and including immediate termination of your employment as well as possible legal repercussions. Additionally, you may be required to participate in a substance abuse rehabilitation or treatment program. If you have questions about this policy or issues related to drug or alcohol use at work, you can raise your concerns with your supervisor or the Owner without fear of reprisal.

Electronic Signature

By checking this box and typing my name below, I am electronically signing this questionnaire.

Signature

Date

AUTHORIZATION FOR RELEASE OF INFORMATION AND WAIVER OF LIABILITY FOR EMPLOYMENT REFERENCES

I hearby authorize

(Employer)

to provide information to my prospective employer pertaining to my employment.

I hereby voluntarily waive any and all rights I may have to privacy and/or confidentiality pertaining to my employment history and work performance insofar as the information is released solely to employers who are evaluating my suitability for employment.

This authorization shall remain valid for 90 days from the date of signature.

I hearby release

(Employer)

from any claims, damages or liabilities of any kind, that may directly or indirectly result from the use, disclosure, or release of such information by any person or party, whether such information is favorable or unfavorable to me, arising from the employment reference as contemplated by this authorization.

I have read the above, understand its contents, and voluntarily agree to its terms.

Electronic Signature

By checking this box and typing my name below, I am electronically signing this questionnaire.

Signature

Date