Employee Application Form

Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Current Date & Time

I. Personal Information

Full Name: *

Have you ever had a different Name? If so, please list it (them) *

Current Address: *

City: *

State *

ZIP: *

Primary Phone Number: *

Email: *

Applying for Position: *

Preferred Location: *

How were you referred to Heroman Services Plant Company, LLC?

Have you ever been convicted of a felony? *

If yes, please explain:

Why are you interested in working for HSPC? *

II. Educational History

High School Name: *

Dates of Attendance: *

Diploma? *

GED: *

College / Technical School Name: *

Dates of Attendance of College: *

Degree in: *

Other Education and Training: *

III. Employment Record Please include all employment for the last three years

1. Current or Most Recent Employer

Current Company Name: *

Current Employer City: *

Current Employer State: *

Current Position Held: *

Date Started - Last Job: *

Date Ended - Last Job: *

Most Recent Manager / Supervisor: *

Most Recent Manager Phone: *

Most Recent Wage / Salary: *

Reason for Leaving Last Job: *

2. Previous Employer

Previous Company Name 1: *

Previous Employer City 1: *

Previous Employer State 1: *

Position Held with Previous Employer 1: *

Date Started with Previous Employer 1: *

Date Ended with Previous Employer: *

1st Previous Manager / Supervisor: *

Previous Employer 1 Phone: *

Wage / Salary at Previous Employer 1: *

Reason for Leaving Previous Employer 1: *

3. Previous Employer

Previous Employer 2 Company Name: *

Previous Employer 2 City: *

Previous Employer 2 State: *

Position Held with Previous Employer 2: *

Date Started - Previous Employer 2: *

Date Ended - Previous Employer 2 : *

Manager / Supervisor - Previous Employer 2: *

Previous Employer 2 Phone: *

Wage / Salary at Previous Employer 2: *

Reason for Leaving Previous Employer 2: *

NOTE: We will contact all of the employers listed on this application unless you specifically exclude them below. Please list any employers you do not want us to contact and your reason for the exclusion:

Employer’s Name and Reason for not contacting them:

IV. Other Experience & Skills

Other Experience and Skills. Please list all that may be relevant to the position you are applying for: *

Hobbies: *

V. Work Availability

1. Date Available to Start *

2. If required, can you work overtime? *

3. Can you work overtime without prior notice? *

4. If required, can you work Saturdays? *

5. If required, can you work Sundays? *

6. Can you travel if required by this position? *

VI. Salary / Hourly Rate Requirements

If your application received favorable consideration, what salary / hourly rate would you require? This information MUST be included for job consideration

Amount: *

Per: *

Hourly

Salary

Inputting your name in the space provided below acknowledge the fact that the information provided in this Application for Employment is true, correct and complete. If you employ me, any misstatement or omission of fact on this application may result in my dismissal. I understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future.

Attach resume if available:

Signature: *

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