/ NATIONAL SALVAGE & SERVICE CORPORATION

Employment Application

Applicant Information

Full Name: /
Date:

Last

/

First

/

M.I.

Address:

Street Address

/

Apartment/Unit #

City

/

State

/

ZIP Code

Phone: /
Email
Date Available: /
Desired Salary:
/ $ /
CDL Class:
Position Applied for:
Are you a citizen of the United States? / YES / NO /
If no, are you authorized to work in the U.S.?
/ YES / NO
Have you ever worked for this company? / YES / NO /
If yes, when?
Have you ever been convicted of a felony? / YES / NO
If yes, explain:

Education

High School: /
Address:
From: /
To:
/
Did you graduate?
/ YES / NO /
Diploma:
College: /
Address:
From: /
To:
/
Did you graduate?
/ YES / NO /
Degree:
Other: /
Address:
From: /

To:

/

Did you graduate?

/ YES / NO /

Degree:

Previous Employment

Company: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Company: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Company: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Military Service

Branch: /

From:

/

To:

Rank at Discharge: /

Type of Discharge:

If other than honorable, explain:

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.

Signature: /

Date:

References

I authorize National Salvage & Service Corporation to conduct a reference check with my present and/or previous employer(s). This also serves to authorize my present and/or previous employer(s) to provide reference information to National Salvage & Service Corporation as it is requested. I understand that reference information may include, but not be limited to, verbal and written inquiries or information about my employment performance, professional demeanor and character, rehire potential, dates of employment, salary and employment history. By providing such authorization, I understand and agree that I release National Salvage & Service Corporation, from any and all claims or potential claims I may have regarding any and all information released to or by National Salvage & Service Corporation and regarding any employment decisions made about me on the basis of such information.

Company Name:
Contact’s Name:
Title/relationship:
Current Address:
Phone Number:
Notes for contacting reference:
Company Name:
Contact’s Name:
Title/relationship:
Current Address:
Phone Number:
Notes for contacting reference:
Company Name:
Contact’s Name:
Title/relationship:
Current Address:
Phone Number:
Notes for contacting reference:
Signature: /

Date:

Printed Name: /

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