Gasempire

I CERTIFY THAT THE INFORMATION PROVIDED IN THIS APPLICATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

IF EMPLOYED, ANY MISSTATEMENT OR OMISSION OF FACT ON THIS APPLICATION MAY RESULT IN MY DISMISSAL.

I UNDERSTAND FAILURE TO COME TO WORK ON TIME, LEAVING EARLY, AND MISSING WORK CAN RESULT IN MY DISMISSAL OF THE JOB.

I UNDERSTAND THAT COMPLETION OF THE APPLICATION DOES NOT CONSTITUTE AN OFFER OF EMPLOYMENT AND SUPERSEDES ANY AGREEMENTS OR UNDERSTANDINGS BETWEEN THE APPLICANT AND EMPIRE GAS SERVICES, LLC. THIS APPLICATION WILL REMAIN VALID FOR SIX MONTHS. I FURTHER UNDERSTAND THAT EMPIRE GAS SERVICES, LLC IS AN AT WILL EMPLOYER AND THAT SHOULD AN OFFER OF EMPLOYMENT BE EXTENDED TO AND ACCEPTED BY ME THAT THIS OFFER OF EMPLOYMENT DOES NOT CREATE A CONTRACTUAL OBLIGATION OF THE EMPLOYER TO CONTINUE TO EMPLOY ME IN THE FUTURE.

I HEREBY AUTHORIZE MY PRESENT AND/OR PAST EMPLOYERS TO RELEASE ALL INFORMATION REGARDING MY EMPLOYMENT. I FURTHER AGREE THAT I WILL NOT HOLD MY PRESENT OR FORMER EMPLOYERS LIABLE FOR ANY INFORMATION RELEASED TO EMPIRE GAS SERVICES, LLC REGARDING MY EMPLOYMENT HISTORY.

I have read & Agree Signature Date

Last Name	First Name	Middle Name	Date Of Birth
Street Address	City	State	Zip
Drivers License #	Social Security #	Email	Telephone

High School and Location	Years Completed	Did You Graduate? YesNo	Degree
College Attended and Location	Years Completed	Did You Graduate? YesNo	Degree
Trade/Business/Technical School & Location	Years Completed	Did You Graduate? YesNo	Degree
Licenses/Certifications	Years Completed	Expiration Date	Degree

Company Name	Address (Number, Street, City, State, ZIP Code)	Phone
Date Employed (Day, Month, Year)	Date Left (Day, Month, Year)	Awards Received
May we contact? YesNo	Supervisor Name	Supervisor Phone
Starting Hourly Pay	Final Hourly Pay	Reason for Leaving

Company Name	Address (Number, Street, City, State, ZIP Code)	Phone
Date Employed (Day, Month, Year)	Date Left (Day, Month, Year)	Awards Received
May we contact? YesNo	Supervisor Name	Supervisor Phone
Starting Hourly Pay	Final Hourly Pay	Reason for Leaving

Company Name	Address (Number, Street, City, State, ZIP Code)	Phone
Date Employed (Day, Month, Year)	Date Left (Day, Month, Year)	Awards Received
May we contact? YesNo	Supervisor Name	Supervisor Phone
Starting Hourly Pay	Final Hourly Pay	Reason for Leaving

Application For Employment

Personal Information

Education

Additional Information

Employment History (List Present or Most Recent Positions First)

SUPPLEMENTAL INFORMATION

IF YOUR POSITION REQUIRES TRAVEL TO VARIOUS JOB SITES OR ON COMPANY ERRANDS, PLEASE COMPLETE THIS SECTION.

COMPLETE THIS SECTION ONLY IF APPLICABLE

Contact

(361) 579-7922

sales@gasempire.com