Pateco Services Employment Application

EMPLOYMENT APPLICATION
Pateco Services, LLC provides equal employment opportunity to all qualified persons, and does not unlawfully discriminate against any person on the basis of race, color, creed, religion, sex, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Please-
- Complete all items on the application, even if the information is included on your resume or other documents submitted by you.
- Sign and date your application.
- Specify the exact title of the position in which you are interested.
Position Applying For*
Office Location*
Personal Information
Full Name*
Address (Street)*
Address (City, State, Zip Code)*
Driver's License (State/Number)*
Telephone Number*
Alternate Telephone Number
Email Address*
example@example.com
General Information
Are you legally eligible for work in the USA? (if yes, verification will be required)*

YesNo
Have you ever applied to or worked for Pateco Services before?*

YesNo
If so, when?
Are any of your relatives currently working for Pateco Services?*

YesNo
If so, please list name and department, if applicable.
Have you ever been convicted of a felony?*

YesNo
If yes, please explain. If no, type "N/A".*
Employment Request
Minimum Salary Requested*
If applicable, are you available for overtime?*

YesNo
What is the earliest date you can begin work?*

MonthDayYear
Date
How did you hear about this position?*

RecruiterInternet Job PostingNewspaper ClassifiedCompany WebsiteOther
Employment History

Please provide a minimum of 10 years of work experience, starting with most recent/current employment.
May we contact your current employer?*

YesNoN/A
Current/Most Recent Employer
Company Name*
Company Address*
Supervisor Name*
Supervisor Telephone*
Dates of Employment: From*

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Indicate "Present" if still employed by this company

Present
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving*
Position Duties*
Employer #2
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Employer #3
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Employer#4
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Employer #5
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Employer #6
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Employer #7
Company Name
Company Address
Supervisor Name
Supervisor Telephone
Dates of Employment: From

MonthDayYear
Date
Dates of Employment: To

MonthDayYear
Date
Pay or Salary at Start of Employment
Pay or Salary at End of Employment
Reason for Leaving
Position Duties
Education

	School Name	Location	Course of Study	Degree Obtained
High School/GED
College/University
Graduate School
Vocational/Specialized

Military
Military Service:*

YesNo
Branch
Specialized Training
References

Please list at least 3 references.

	Reference Name	Company	Title	Contact Information
Reference #1
Reference #2
Reference #3
Reference #4

Residential History

Please provide a minimum of 3 years of residential history, starting with most recent/current residence.

	Street Address	City	Sate	Zip	Dates Occupied
Residence #1
Residence #2
Residence #3
Residence #4
Residence #5
Residence #6
Residence #7
Residence #8
Residence #9

Certification
I certify that the facts set forth in this application are true, complete, and correct to the best of my knowledge. I understand that any misrepresentations, falsifications, or omissions on this application can be grounds for rejection of my application or, if I am employed by this company, for my immediate termination from employment. I authorize Pateco Services, LLC to make any necessary inquiries and investigations into my education, military, employment, or residential history. I further authorize, unless otherwise indicated on this application, the release of my information to Pateco Services, LLC by any of the schools, services, or employers
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

EMPLOYMENT APPLICATION

Personal Information

General Information

Employment Request

Employment History

Current/Most Recent Employer

Employer #2

Employer #3

Employer#4

Employer #5

Employer #6

Employer #7

Education

Military

References

Residential History

Certification