Eagle Resource Group, Inc. Employment Application

Name:*

First NameLast Name

Phone Number:*

Enter 10 digit phone number

E-mail Address:*

Confirmation Emailexample@example.com

Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Are you eligible to work in the United States?*

YesNo

Have you pleaded guilty or been convicted of a crime or misdemeanor?

YesNo

Are you 18 years of age or older?*

YesNo

How did you hear about us?*

Friend, social media, ad, job board

Job Skills & Training

Which position are you applying for?*

Accounting, Clerical, Developer, Warehouse, etc.

Type of Employment Desired:

Please select one

Date Available:

MonthDayYear

Are you currently employed?

YesNo

If YES, what is your current job title and department?

If required for position, do you have a valid driver's license?

YesNo

Have you ever worked for a temporary agency?

YesNo

If YES, which agencies?

Education

Rows	Name of School	City/State	Did you graduate?	If No, # of year left to graduate	If Yes, date of graduation	Degree Received	Major
High School
GED
College
Graduate School
Other

Other credentials/licenses/professional affiliations, etc. which are relevant to the job(s) for which you are applying.

List any trainings, certifications or skills that are relevant to the position you are applying for.

SKILLS: Please list technical skills, clerical skills, trade skills, etc., relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge, and note your level of proficiency (basic, intermediate, expert).

Work Experience

Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary at the bottom of this form. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer committments.

PLEASE DO NOT complete this information with the notation "See Resume."

PLEASE NOTE: Eagle Resource Group, Inc. reserves the right to contact all current and former employers for reference information.

Most Recent Position

Start Date

MonthDayYear

End Date

MonthDayYear

Employment Status

Full-timePart-time

If part-time, how many hours per week?

Starting Salary

ex: 12/hr or 25,000/yr

Final Salary

ex: 12/hr or 25,000/yr

Company Name

Company Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Supervisor Name

First NameLast Name

Supervisor Title

ex. Supervisor, Manager, Director

Supervisor Phone Number

Please enter a valid phone number.

Reference Name

First NameLast Name

How is the reference related to you?

ex. Co-worker, family, friend

Reference Phone Number

Please enter a valid phone number.

May we contact your current reference(s)?

At any timeOnly if I am a finalist candidate

Primary Duties:

Reason for Leaving:

Previous Position 1

Start Date

MonthDayYear

End Date

MonthDayYear

Employment Status

Full-timePart-time

If part-time, how many hours per week?

Starting Salary

Final Salary

Previous Company 1 Name

Previous Company 1 Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Supervisor Name

First NameLast Name

Supervisor Title

Supervisor Phone Number

Please enter a valid phone number.

Reference Name

First NameLast Name

How is the reference related to you?

ex. Co-worker, family, friend

Reference Phone Number

Please enter a valid phone number.

May we contact your reference(s)?

At any timeOnly if I am a finalist candidate

Primary Duties:

Reason for Leaving:

Previous Position 2

Start Date

MonthDayYear

End Date

MonthDayYear

Employment Status

Full-timePart-time

If part-time, how many hours per week?

Starting Salary

Final Salary

Previous Company 2 Name

Previous Company 2 Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Supervisor Name

First NameLast Name

Supervisor Title

Supervisor Phone Number

Please enter a valid phone number.

Reference Name

First NameLast Name

How is the reference related to you?

ex. Co-worker, family, friend

Reference Phone Number

Please enter a valid phone number.

May we contact your reference(s)?

At any timeOnly if I am a finalist candidate

Primary Duties:

Reason for Leaving:

(Optional) Upload Resume and any other relevant files:

PDF, Word doc

Signature*

Date

Hour MinutesAM/PM Option

Are you human?*