Employment Application I understand* All applicants agree to a background check and drug screen. Date MM slash DD slash YYYY Name* First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Alabama Driver's License # Expiration Date MM slash DD slash YYYY PhoneEmail Position Salery DesiredDateYou Can Begin MM slash DD slash YYYY Are you currently employed? Yes No Employment History (LAST FOUR EMPLOYERS - LIST MOST RECENT FIRST)#1 Company Name #1 Position Held #1 Salary#1 From Date MM slash DD slash YYYY #1 To Date MM slash DD slash YYYY #1 Supervisor's Name First Last #2 Company Name #2 Position Held #2 Salary#2 From Date MM slash DD slash YYYY #2 To Date MM slash DD slash YYYY #2 Supervisor's Name First Last #3 Company Name #3 Position Held #3 Salary#3 From Date MM slash DD slash YYYY #3 To Date MM slash DD slash YYYY #3 Supervisor's Name First Last #4 Company Name #4 Position Held #4 Salary#4 From Date MM slash DD slash YYYY #4 To Date MM slash DD slash YYYY #4 Supervisor's Name First Last EducationAre you a US Military Veteran? Yes No Date of Entry MM slash DD slash YYYY Date of Separation MM slash DD slash YYYY US Military or Navel Service Branch Rank Name of High School Years attended HS?Did you graduate HS? Yes No Name of Trade School Years Attended TS?Did you graduate TS? Yes No Name of College/Other Years attended college/other?Did you graduate college/other? Yes No List Special Training/SkillsReferencesLIST THREE (3) PEOPLE NOT RELATED TO YOU WHOM YOU’VE KNOWN FOR AT LEAST ONE YEARReference #1 Name First Last Reference #1 PhoneYears Known Reference #1Reference #2 Name First Last Reference #2 PhoneYears Known Reference #2Reference #3 Name First Last Reference #3 PhoneYears Known Reference #3AuthorizationI certify that the facts contained in this Application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this Application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information that may have, personal or otherwise, and release Springer Equipment Company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of Springer Equipment Company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized Springer Equipment Company representative.eSignature Date MM slash DD slash YYYY PhoneThis field is for validation purposes and should be left unchanged.