East to West Solar Employment Application

Personal Information Full Name: Address: City: Phone Number: Social Security Number: Date of Birth:

Employment History Please list your last three employers, starting with the most recent.

1. Company Name: Address: Position: May we contact this employer? Yes / No

2. Company Name: Address: Position: May we contact this employer? Yes / No

3. Company Name: Address: Position: May we contact this employer? ________

Driving Record Do you have a valid driver's license or ID card? ________ If yes, please provide your driver's license or ID card number_________________ Have you had any accidents or moving violations in the past three years? Yes / No If yes, please provide details:__________________________________________________________________________________________________________________________________

Physical Examination Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation? Yes / No If no, please describe the functions that cannot be performed: Are you willing to complete a physical examination? ________________________________________________________________________________________________________________________________________

Drug Testing Are you willing to submit to a pre-employment drug test? ____________ Are you willing to submit to random drug testing? ___________Background Check Are you willing to undergo a background check?___________

 References Please provide the names and contact information of three professional references.

I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that any false statements or omissions may result in disqualification from employment or termination of employment if already employed.