Employment Application

APPLICATION FOR EMPLOYMENT

Step 1 of 6

INSTRUCTIONS
PLEASE ANSWER ALL QUESTIONS. Resumes are not accepted in lieu of completion of this application. Note: This document was designed to use with several types of positions. Some questions may not be completely applicable to the job/position you are seeking; however, we ask that you fully complete all areas of information.
APPLICANT INFORMATION
Position(s) applied for*
Please enter (other) position applying for
Date of application*
MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Telephone #*
Other Phone
Email*
Are you under the age of 18? (NOTE: If yes, you may be required to furnish proof of exemption or partial waiver as detailed by your State Child Labor Law.)*
- Yes
- No
Date available for work?
MM slash DD slash YYYY

(NOTE: You will be required to provide appropriate document(s) for completion of the I-9 at the time of employment)
Type of employment desired*
- Full-time
- Part-time
- Temporary
- Seasonal
- Educational Co-op

EDUCATION DATA
- High School
Print Name
School Address
Street Address Address Line 2 City State ZIP Code
No. of Yrs. Completed
Degree
Major Course of Study
- College
Print Name
School Address
Street Address Address Line 2 City State ZIP Code
No. of Yrs. Completed
Degree
Major Course of Study
- Graduate School
Print Name
School Address
Street Address Address Line 2 City State ZIP Code
No. of Yrs. Completed
Degree
Major Course of Study
- Trade, Bus., Night or Correspondence
Print Name
School Address
Street Address Address Line 2 City State ZIP Code
No. of Yrs. Completed
Degree
Major Course of Study
Honors received

REFERENCES

Three individuals, not relatives whom you have known at least one (1) year.
Name 1*
Address 1*
Street Address Address Line 2 City State ZIP Code
Telephone 1*
Years Known 1*
Name 2
Address 2
Street Address Address Line 2 City State ZIP Code
Telephone 2
Years Known 2
Name 3
Address 3
Street Address Address Line 2 City State ZIP Code
Telephone 3
Years Known 3

EMPLOYMENT EXPERIENCE

LIST YOUR LAST FOUR PREVIOUS EMPLOYERS (most recent first). Account for all time periods including unemployment, self-employment and military service. This section must be completed in full in addition to any attached resume.
Employer*
Dates Employed - From*
MM slash DD slash YYYY
Dates Employed - To*
MM slash DD slash YYYY
Immediate Supervisor
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Hourly Rate/Salary - Starting
Hourly Rate/Salary - Final
Telephone Number
Work Performed
Reason for Leaving
Employer
Dates Employed - From
MM slash DD slash YYYY
Dates Employed - To
MM slash DD slash YYYY
Immediate Supervisor
Address
Street Address Address Line 2 City State ZIP Code
Job Title
Hourly Rate/Salary - Starting
Hourly Rate/Salary - Final
Telephone Number
Work Performed
Reason for Leaving
Employer
Dates Employed - From
MM slash DD slash YYYY
Dates Employed - To
MM slash DD slash YYYY
Immediate Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Hourly Rate/Salary - Starting
Hourly Rate/Salary - Final
Telephone Number
Work Performed
Reason for Leaving
Employer
Dates Employed - From
MM slash DD slash YYYY
Dates Employed - To
MM slash DD slash YYYY
Immediate Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Hourly Rate/Salary - Starting
Hourly Rate/Salary - Final
Telephone Number
Work Performed
Reason for Leaving
Employer
Dates Employed - From
MM slash DD slash YYYY
Dates Employed - To
MM slash DD slash YYYY
Immediate Supervisor
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Hourly Rate/Salary - Starting
Hourly Rate/Salary - Final
Telephone Number
Work Performed
Reason for Leaving
Please provide an explanation for any lapse of employment
Have you ever been dismissed or forced to resign from an employment?*
- Yes
- No
If yes, please explain.*

APPLICANT’S STATEMENT, AUTHORIZATION, AND RELEASE
By submitting this application or other documents, I agree to conform to the rules and regulations of the Company, including an Introductory Period (if applicable). I certify that the information provided in this Application for Employment is correct and complete. I authorize the investigation of this information and give permission for the Company, or their designated representatives to contact schools, previous employers, personal references and others to verify the data I have supplied. I release and indemnify the Company from any claims or liability resulting from such inquiry. In addition, I release the schools, my previous employers, and other individuals from all liability as a result of responding to such inquiries. I understand that my misrepresentation, omission of fact(s), or incomplete information may disqualify me for employment with the Company. In addition, if I am employed by the Company, any discovery of misrepresentation or omission of fact(s) on this Application for Employment following my employment may result in discipline up to and including termination.

I understand and agree as a condition of continued employment that I will be required to take a drug and/or alcohol test as part of any work related accident investigation.

I understand that employment with the Company is for no guaranteed period of time and may be terminated by myself, the Company with or without notice. I acknowledge that any promise, policies, business practices, procedures, or documents (including the Company’s Employee Handbook) do not constitute an employment contract or modification of the at-will employment relationship between Company and myself.
- Note: Complete details of the Company’s Drug Free Workplace Policy (if any) will be provided during the interview process.
THE COMPANY’S STATEMENT
The Company complies with the Americans with Disabilities Act of 1990. During the interview process, you may be asked questions regarding your ability to perform job-related responsibilities. If the Company extends an offer of employment to you, you may be required to complete a post-job offer medical history questionnaire and/or undergo a medical examination or drug screening.

The Company is an equal employment opportunity employer. It is the policy of the Company to make employment decisions without regard to race, color, religion, sex, age, national origin disability, sexual orientation, marital status or any other protected category.

Applicants who are accepted for employment with the Company should understand that while every effort is made to provide continuous work, there are no employment contracts and the permanency of any position is not guaranteed.

FAIR CREDIT REPORTING ACT NOTIFICATION
You are notified that in connection with your application for employment (including contract for services) and/or active employment with the Company, a consumer report and/or investigative report which may contain public record information may be requested and/or made on you. This report may include consumer credit, criminal records, driving records, education history, prior employer verification and other information for the purpose of considering you for employment, promotion, reassignment or retention with the Company.

These reports may include information regarding your career experience along with reasons for termination of past employment, information regarding your character, reputation, personal characteristics and/or mode of living and will be obtained from public or private record sources or through personal interviews. Information may also be requested from various Federal, State, local or other agencies.

Before a consumer and/or investigative report is requested, you will be asked to complete a Disclosure and Consent Form. You will be provided the name and address of the consumer-reporting agency to which the request for information is being made. You will have the right to a complete disclosure of the nature and scope of the investigation and a written summary of your rights under the Fair Credit Reporting Act.
AME Statements
Ashton Manor Environmental, LLC is an Equal Opportunity company and EEO/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications, and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation. I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, may be sufficient cause to (i) cancel further consideration of the application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any rights and claims I may have regarded the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves that same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s President. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.

I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO TAKE A POLYGRAPH, LIE DETECTOR, OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100. (THIS STATEMENT IS REQUIRED BY MARYLAND LAW.)
Affirmative Action Voluntary Information
COMPLETION OF INFORMATION BELOW IS VOLUNTARY We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria. Please be advised that this survey is not a part of your official application for employment. It will not be used in any hiring decision.

This information will be used and kept confidential in accordance with applicable laws and regulations
Race - Please check one of the following Equal Employment Opportunity Identification Groups:
- Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
- American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affliction or community attachment.
- Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent including, for example, Cambodia, China, India, Japan, Korea,Malaysia, Pakistan, the Philippine Islands, Thailand, Vietnam.
- Black or African American (Not Hispanic or Latino) - A person having origins in any of the Black racial groups of Africa.
- Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
- White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
- Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five.
Date*
MM slash DD slash YYYY

Service Oriented. Community Driven.

Proudly serving Carroll, Baltimore, Howard, and Frederick Counties, including Hampstead, Owings Mills, Reisterstown, Taneytown, Finksburg, Monkton, and Parkton for over 35 years!

Get Social With Us!

Join Our Team

Contact Us!

2914 Hanover Pike
Manchester, MD 21102

Telephone: 410-840-8766

Email: info@legacyseptic.com

Text: 240-372-2744

Employment Application

APPLICATION FOR EMPLOYMENT

Step 1 of 6

INSTRUCTIONS

APPLICANT INFORMATION

SKILLS AND QUALIFICATIONS

EDUCATION DATA

REFERENCES

EMPLOYMENT EXPERIENCE

APPLICANT’S STATEMENT, AUTHORIZATION, AND RELEASE

THE COMPANY’S STATEMENT

FAIR CREDIT REPORTING ACT NOTIFICATION

AME Statements

Affirmative Action Voluntary Information

Service Oriented. Community Driven.

Get Social With Us!

Contact Us!