SSEC EMPLOYMENT APPLICATION

Please complete the entire application.

Employer: SSEC | Selby Soil Erosion Control | SSEC-APEX

Address: PO Box 1330

City/State/ZIP: Newcaslte, California 95658

Telephone: 530.887.9894

It is the policy of SSEC | Selby Soil Erosion Control | SSEC-APEX to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

Applicants Full Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Phone*

Please enter a valid phone number.

Email:*

example@example.com

Driver's License (State/Number):*

Class AClass BClass C

Job Position Applied For:

Full TimePart Time

YesNo

If yes, when?

YesNo

If yes, when?

YesNo

If no, please state any limitations:

YesNo

As Soon As PossibleA Specific Date

Date when you would be available to begin work:

Date

YesNo

What reasonable accommodation, if any, would you request?

YesNo

What Union(s) are you affiliated with?*

YesNo

List any skills that may be useful for the job you are seeking. Include the number of years of experience and select your experience level associated with the skill.

YesNo

College and/or University Name

YesNo

If yes, degree(s) received:

Please add any additional training experience (graduate. technical, vocational):

Please indicate any current professional licenses or certifications that you hold:

Please add any awards, honors, special achievements:

YesNo

If yes:

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

List your current or most recent employment first. Please list all jobs (including self- employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment.

Please sign the certification, attach any necessary documents and email to the address listed on the next page.

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize SSEC | Selby Soil Erosion Control | SSEC-APEX to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Human Resources Manager, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the same right. Moreover, no agent, representative, or employee of SSEC | Selby Soil Erosion Control | SSEC-APEX, except in a specific written contract of employment signed on behalf of the organization by its Human Resources Manager, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

APPLICANT SIGNATURE*

DATE*

Date

EMPLOYMENT APPLICATION

Employer Information

Applicant Information

Applicant Employment History

CERTIFICATION