Application Form

City Waste Inc is an equal opportunity employer and does not discriminate on the basis of age, race, creed, color, handicap, marital status, sex, national origin, ancestry, sexual orientation, arrest or conviction record, or veteran status.

Name*

First Last

Social Security Number*

Present Address*

Street Address City State Zip

Is Permanent Address Same?*

Yes
No

Permanent Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number*

Are you 18 years of age or older?*

Yes
No

Commercial Drivers License No.*

Classification*

Are you licensed to drive Interstate?*

Yes
No

Employment Desired

Position(s) applying for:*

Full Time
Part Time

Date you can start?

Rate of pay you expect per hour?

Have you filed for an application of employment with us before?*

Yes
No

Indicate special qualifications or skills:

EDUCATION

List your educational experience which you believe is relevant for the position you are applying for.

High School - Name and Location:

High School - Years completed

High School - Did you graduate?

Yes
No

High School Course of study:

College Name and Location:

College number of years completed

College - Did you graduate?

Yes
No

College - Course of study:

Other Education (please specify) Name and Location:

Other - Number of years completed

Other- Did you graduate?

Yes
No

Other - Course of study:

References

Names and addresses (not former employers or relatives

Reference Name - 1

Address

Telephone Number

Years acquainted?

Reference Name - 2

Address

Telephone Number

Years acquainted?

Reference Name - 3

Address

Telephone Number

Years acquainted?

Relatives and/or firends employed by City Waste, Inc.

Friend/Relative name

Relationship

Friend/Relative name

Relationship

EMPLOYMENT HISTORY

Employer 1

Employer 1 - Company Name & Address

Employer 1 - Contact Name

Employer 1 - Contact Number

Employer 1 - Position/Work Performed

Work Dates - From: mm/yyyyy TO mm/yyyyy

Wage/Salary

Reason for leaving?

Employer 2

Employer 2 - Company Name & Address

Employer 2 - Contact Name

Employer 2 - Contact Number

Employer 2 - Position/Work Performed

Work Dates - From: mm/yyyyy TO mm/yyyyy

Wage/Salary

Reason for leaving?

Employer 3

Employer 3 - Company Name & Address

Employer 3 - Contact Name

Employer 3 - Contact Number

Employer 3 - Position/Work Performed

Work Dates - From: mm/yyyyy TO mm/yyyyy

Wage/Salary

Reason for leaving?

Are you currently working?

Yes
No

Are you able to perform, with or without reasonable accommodation, the job functions of the positions for which you are applying?

Yes
No

READ BEFORE SIGNING

I certify that the information contained in this application is true and complete to the best of my knowledge, and I authorize City Waste, Inc., to investigate all statements made, and understand that the falsification of this application in any detail may result in disqualification from further consideration or dismissal from employment. I release every person seeking or providing information from all liability or legal claims. I understand that employment with City Waste, Inc., is at will, terminable at any time by City Waste, Inc., at its sole discretion with or without cause and with or without notice. I further understand that such employment is not contractual, and remains as such unless and until an express written contract is entered into and executed in writing by me and City Waste, Inc. and that no contract is formed or offered by this application or any employment handbook I understand the employment City Waste, Inc., is pursuant to terms and conditions established by City Waste, Inc., and are subject to change without notice. I certify that I have read and understand the above verification.

Acceptance & Signature*

I agree to the above conditions and to City Waste , Inc Privacy Policy

Driver Background Check

DRUG SCREENING
City Waste, Inc., have a vital interest in maintaining a safe working environment for its ämp!oyees and providing a quality service to its customers. Therefore, passing a drug screening test will be a condition of employment.

I hereby authorize any previous employer(s) ( within two years of date listed) to release any and all drug and alcohol test information to City Waste Inc., upon receipt of this request. This information is required per U.S.D.O.T. regulations.*

I accept

WORK REFERENCE RELEASE

I hereby authorize any former employer to release to City Waste, Inc., any information such former employer may have relating to my employment, such information to be either verbal or written form, I hereby release to City Waste, Inc., and any former employer, and any of their employees and agents from any liability or claim which may arise from the transfer or receipt of any such information.*

I accept