MILLER PORTABLES JOB APPLICATION

Equal Employment Opportunity Statement: Employment decisions will be based on the principles of equal opportunity. All personnel actions (recruiting, hiring, training, promotion, compensation, etc are administered without regard to any characteristic protected by state, federal, or local law, assuming said characteristic does not interfere with the performance of essential job functions. Reasonable accommodations will be made for disabilities and religious beliefs. Please inform us of any necessary accommodations to the application process. Please print your answers.

First*

Middle

Last Name*

Address*

Street / Address

Street Address Line 2

CityState

Zip Code

Telephone Number*

Format: (000) 000-0000.

Social Security Number*

Date of Birth*

Date

Branch Applying To*

Position (s) Applied For*

Desired Pay*

Date of Application*

Date

Email Address*

example@example.com

Drivers License*

How did you learn about Miller Portables?*

AdvertisementEmployment AgencyEmployee ReferralOther

If you found out about us through an advertisement, could you please specify where you saw it?: *

If you learned about us through an employment agency, please indicate the name of the agency*

If you were referred by an employee, please provide their name: *

If you selected 'Other' as your source, please specify how you heard about us:*

Have you applied for a position with us before?*

Yes.No.

Specify date.

Have you ever been employed with us before?*

Yes.No.

Specify date and position.

Are you currently employed?*

Yes.No.

Are you currently on "lay off" status and subject to recall?*

Yes.No.

On what date would you be available for work*

Date

Are you available to work:

Full TimePart-TimeAll shiftsTemporary

Can you travel for work if necessary?

Yes.No.

Are you legally permitted to work in the United States? (Note: Proof of eligibility work be required within three working days of employment.)*

Yes.No.

Are you 18 years of age or older?*

Yes.No.

Are you willing to take drug tests at the Company's request?*

Yes.No.

Have you ever been convicted of a felony?*

Yes.No.

If yes explain:

Have you been told essential functions of the job or have you viewed a copy of the job description listing the essential functions of the job?

Yes.No.

Can you perform these essential functions of the job with or without reasonable accommodation?

Yes.No.

Have you ever gone by a name other than the one listed above?*

Yes.No.

If yes explain:

Highest level of education:*

Graduated high schoolSome CollegeGraduated college

Employer*

Supervisor*

Address*

Phone Number*

Format: (000) 000-0000.

Position Title and Duties*

Starting Date*

Date

Ending Date*

Date

Starting Pay *

Ending Pay*

Why did you leave this job*

May we contact this employer?*

Yes.No.Later

Employer #2

Supervisor

Address

Phone Number

Format: (000) 000-0000.

Position Title and Duties

Starting Date

Date

Ending Date

Date

Starting Pay

Ending Pay

Why did you leave this job

May we contact this employer?

Yes.No.Later.

Employer #3

Supervisor

Address

Phone Number

Format: (000) 000-0000.

Position Title and Duties

Starting Date

Date

Ending Date

Date

Starting Pay

Ending Pay

Why did you leave this job

May we contact this employer?

Yes.No.Later.

Reference #1 (Full Name)*

Reference #1 (Phone Number)*

Reference #1 (Email)

example@example.com

Reference #1 (Years Known)*

Reference #2 (Full Name)*

Reference #2 (Phone Number)*

Reference #2 (Email)

example@example.com

Reference #2 (Years Known)*

Reference #3 (Full Name)*

Reference #3 (Phone Number)*

Reference #3 (Email)

example@example.com

Reference #3 (Years Known)*

I certify that the information in this application is true, to the best of my knowledge.

| understand that providing false or misleading information at any time during the application and interview process may lead to refusal to hire or discharge from the Company. If I become employed by the Company, I agree to follow all rules and regulations of the Company as they develop and change.

I allow the Company to conduct investigations on me, my background, and my performance, and am aware that such investigations will become a part of my employment record. With this, I authorize that Company to speak with my acquaintances, personal and professional, to gather information about me.

I authorize all former employers and references to provide any information about me to the Company and release them of liabilities and damages of all kinds for providing this information. I authorize the Company to verify the accuracy of the information within this application. I also authorize the release of my educational transcripts to the Company for education verification purposes.

I release MT Services, Inc dba Miller Portables from liability for collecting information about me and using it to make employment decisions.

If I become employed by the Company, I understand that the employment relationship will be "at will," and that the "at will" status may not change at any time unless specifically approved, in writing, by the President of the Company.

I agree that if I become indebted to the Company, I will be responsible for repaying the total owed upon termination from the Company. If I do not repay the sum prior to my final paycheck being received, the money owed will be deducted from my pay.

This application for employment is valid for the next 90 days. I understand that if I wish to be considered for employment after this period of time, I must apply again.

Signature of Applicant*

Date of Signature*

Date

Application for Employment

Employment History

Applicant's Signature