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Employment Application


    Present Address

    How long have you lived at this address?


    Email Address

    Employment desired

    Position applying for

    Are you able to work : If NO, explain below

    Salary desired


    Date available for employment?



    Are you over 18?


    Applying for a Driving Position? Must be over 25

    Rate yourself from 1 (Poor) to 10 (Best)

    Team Work

    Mechanical Skills

    Safe Driving Skills

    Customer Service Skills

    Sales Abilities

    Have You Ever Been In The

    Armed Forces?

    National Guard?


    Date Entered

    Discharge Date

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    High School


    Bus. or Trade School

    Professional School

    Do you have reliable transportation to work?

    Do You Have A Valid Driver's License?

    State of issue

    Have you had any accidents during the past three years?

    How many?

    Have you had any moving violations during the past three years?

    How Many?

    Have You Ever Been Convicted Of A Crime, Plead Guilty To A Crime, Dwi Or Received A Deferred Adjudication For A Crime?

    Crime (s)

    Nature of offense(s)


    Sentence Imposed

    Type of Rehabilitation

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    Please list two references other than relatives or previous employers.

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    Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

    Name of employer

    Name of last supervisor

    Employment dates

    Pay or salary

    Salary From


    Salary Start

    Salary End

    Your last job title

    Reason for leaving (be specific)

    List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

    May we contact your present employer?

    Did you complete this application yourself If not, who did?

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    Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
    In exchange for the consideration of my job application by Hose Tech USA ("the Company"), I agree that: Employment with the Company is under an employment-at-will relationship. Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Company, or otherwise to change in any respect the employment-at-will relationship, and that the employment-at-will relationship cannot be altered except by a written instrument signed by the President/Owner of the Company. Both I and the Company may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.
    I authorize investigation of all statements contained in this application. I have provided truthful and complete information in response to the questions in this application, and I understand that the misrepresentation or omission of facts called for is good cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company and my schools, previous employers, references, and others from any liability as a result of such contact.
    I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.
    I understand that, in connection with the routine processing of my employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

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