Trivium Employment Application

Trivium Employment Application
Applicant Information
Full Name

First NameMiddle NameLast Name
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Street Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City, State, ZIP
Availability
Availability
Shift Preference
Available Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employment History
Employer #1 Company Name
Employer #1 Job Title
Employer #1 Dates Employed
Employer #1 Reason for Leaving
Employer #2 Company Name
Employer #2 Job Title
Employer #2 Dates Employed
Employer #2 Reason for Leaving
Employer #3 Company Name
Employer #3 Job Title
Employer #3 Dates Employed
Employer #3 Reason for Leaving
Education
High School
Total Years
Diploma/Equivalency?
College
Total Years
Degree
Other (Trade, etc.)
References (Professional Only)
Reference 1 Name

First NameMiddle NameLast Name
Reference 1 Relationship
Reference 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2 Name

First NameMiddle NameLast Name
Reference 2 Relationship
Reference 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Reference 3 Name

First NameMiddle NameLast Name
Reference 3 Relationship
Reference 3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Driver’s License Information
Do you have a valid driver’s license?
State Issued
Legal Work Eligibility
Are you legally eligible to work in the United States?
Do you meet the minimum age requirement for the position?
Felony Disclosure
Have you ever been convicted of a felony?
If yes, please explain
Authorization and Signature
Certification Statement
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Background Check Consent (Release of Information)
Consent Disclaimer: (please read in its entirety)

In connection with this request, I authorize and release all current/former employers,
corporations, educational institutions, law enforcement agencies, courts (city, county,
state, and federal) to release information regarding my background. This information
includes, but is not limited to employment information, education, driving record, criminal
record, general public records. This form releases the previously mentioned parties from
any liability and responsibility for collecting the above information. I understand that by
providing my consent, I am providing permission for Trivium LLC to obtain this information
on an annual basis.
Consent to conduct a background check
First Name
Middle
Last Name
Please list any aliases or former last names.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Social Security Number
Driver's License Number
State Issued
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Counties Lived in for the Last Three (3) Years
Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Trivium Employment Application

Applicant Information

Availability

Employment History

Education

References (Professional Only)

Driver’s License Information

Legal Work Eligibility

Felony Disclosure

Authorization and Signature

Background Check Consent (Release of Information)

Trivium LLC