ESI Job Application

PLEASE ANSWER ALL QUESTIONS. RESUMES ARE NOT A SUBSTITUTE FOR A COMPLETED APPLICATION.

Cover Letter and Resume: Please explain why you feel qualified for this position and why you want to work at ESI.

Maximum file size: 33.55MB

We are an equal opportunity employer. Applicants are considered for positions without regard to veteran status, uniformed servicemember status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.

Name

First

Last

Position Applied For (list only one)

Telephone Number

Alternate/Cellular Telephone Number

Address

City

State/Province

Zip/Postal

How long have you lived there?

Email

If under the age of 18, can you produce the necessary work certificate at the time of employment?

Yes

No

Type of employment desired?

Full-time

Part-time

Specify Hours

Are you willing to work overtime?

Yes

No

Date on which you can start work if hired:

Have you previously applied for employment with ESI Total Fuel Management?

Yes

No

If Yes, when and where did you apply?

Have you ever been employed by ESI Total Fuel Management?

Yes

No

If Yes, provide dates of employment, location and reason for separation from employment.

If applicable, please list below any other names by which you have been known, as this may be necessary to allow us to confirm your work and educational record. For example: change of name, use of an assumed name, marriage, nickname, etc.

Education

High School

City

State/Province

Zip/Postal

Course of Study or Major

Did you graduate?

Yes

No

Number of years completed

Honors received

College

City

State/Province

Zip/Postal

Course of Study or Major

Did you graduate?

Yes

No

Number of years completed

Honors received

Graduate/Professional

City

State/Province

Zip/Postal

Course of Study or Major

Did you graduate?

Yes

No

Number of years completed

Honors received

Trade or Technical

City

State/Province

Zip/Postal

Course of Study or Major

Did you graduate?

Yes

No

Number of years completed

Honors received

Work Experience

Please list the names of your present and/or previous employers in chronological order with present or most recent employer listed first. Provide information for at least the most recent ten (10) year period. Attach additional sheets if needed. If selfemployed, supply firm name and business references. You may include any verifiable work performed on a volunteer basis, internships, or military service. Your failure to completely respond to each inquiry may disqualify you for consideration from employment. Do not answer "see résumé."

Employer

Address

Type of business

Telephone

Start date of employment

End date of employment

Job title

Duties

Supervisor's name

May we contact?

Yes

No

If No, why not?

Starting wages

Ending wages

Reason for leaving

What will this employer say was the reason for your employment terminated?

Were you ever disciplined?

Yes

No

If yes, for what?

How much notice did you give when resigning?

If none, explain.

Work Experience

Employer

Address

Type of business

Telephone

Start date of employment

End date of employment

Job title

Duties

Supervisor's name

May we contact?

Yes

No

If No, why not?

Starting wages

Ending wages

Reason for leaving

What will this employer say was the reason for your employment terminated?

Were you ever disciplined?

Yes

No

If yes, for what?

How much notice did you give when resigning?

If none, explain.

Have you ever been terminated or asked to resign from any job?

Yes

No

If yes, how many times?

Has your employment ever been terminated by mutual agreement?

Yes

No

If yes, how many times?

Have you ever been given the choice to resign rather than be terminated?

Yes

No

If yes, how many times?

If you answered Yes to any of the above three questions, please explain the circumstances of EACH occasion.

Work Related References

Please list the names of additional work-related references we may contact. Individuals with no prior work experience may list school or volunteer-related references.

Name

Position

Company

Work relationship (supervisor, co-worker)

Telephone

Name

Position

Company

Work relationship (supervisor, co-worker)

Telephone

Personal References

Please list the names of personal references (not previous employers or relatives) who you know that we may contact.

Name

Occupation

Address

Telephone

Number of years known

Name

Occupation

Address

Telephone

Number of years known

Driving Information

Please complete this section only if driving is an essential function of the job for which you are applying.

Do you have a current valid driver's license?

Yes

No

License number

State

Expiration date

If you do not have a driver's license for the state in whcih you currently reside, why not?

Has your license ever been suspended or revoked?

Yes

No

If yes, explain

Do you have personal automobile insurance?

Yes

No

If no, explain

Have you ever been denied personal automobile insurance or has it ever been terminated or suspended?

Yes

No

If yes, please explain

Traffic Violations

Please list all moving traffic violations in the past five (5) years:

Offense

Date

Location

Comments

Offense

Date

Location

Comments

APPLICANT CERTIFICATION

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver's license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside. I understand that the Company may now have, or may establish, a drug-free workplace or drug and/or alcohol testing program consistent with applicable federal, state, and local law. If the Company has such a program and I am offered a conditional offer of employment, I understand that if a pre-employment (post-offer) drug and/or alcohol test is positive, the employment offer may be withdrawn. I agree to work under the conditions requiring a drug-free workplace, consistent with applicable federal, state, and local law. I also understand that all employees of the location, pursuant to the Company's policy and federal, state, and local law, may be subject to urinalysis and/or blood screening or other medically recognized tests designed to detect the presence of alcohol or illegal or controlled drugs. If employed, I understand that the taking of alcohol and/or drug tests is a condition of continual employment and I agree to undergo alcohol and drug testing consistent with the Company's policies and applicable federal, state, and local law. If employed by the Company, I understand and agree that the Company, to the extent permitted by federal, state, and local law, may exercise its right, without prior warning or notice, to conduct investigations of property (including, but not limited to, files, lockers, desks, vehicles, and computers) and, in certain circumstances, my personal property. I understand and agree that as a condition of employment and to the extent permitted by federal, state, and local law, I may be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement. I certify that all the information on this application, my résumé, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of any information may result in disqualification from consideration for employment or, if employed, disciplinary action, up to and including immediate dismissal.

OF ANY PROVISION IN THIS APPLICATION, IF HIRED, THE COMPANY OR I MAY TERMINATE THE EMPLOYMENT RELATIONSHIP AT ANY TIME, FOR ANY REASON, WITH OR WITHOUT CAUSE OR NOTICE. NOTHING IN THIS APPLICATION OR IN ANY DOCUMENT OR STATEMENT, WRITTEN OR ORAL, SHALL LIMIT THE RIGHT TO TERMINATE EMPLOYMENT AT-WILL. NO OFFICER, EMPLOYEE OR REPRESENTATIVE OF THE COMPANY IS AUTHORIZED TO ENTER INTO AN AGREEMENT—EXPRESS OR IMPLIED—WITH ME OR ANY APPLICANT FOR EMPLOYMENT FOR A SPECIFIED PERIOD OF TIME UNLESS SUCH AN AGREEMENT IS IN A WRITTEN CONTRACT SIGNED BY THE PRESIDENT OF THE COMPANY.IF HIRED, I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF THE COMPANY, AND I UNDERSTAND THAT THE COMPANY HAS COMPLETE DISCRETION TO MODIFY SUCH RULES AND REGULATIONS AT ANY TIME, EXCEPT THAT IT WILL NOT MODIFY ITS POLICY OF EMPLOYMENT AT-WILL. I authorize the Company or its agents to confirm all statements contained in this application and/or résumé as it relates to the position I am seeking to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation which may be permitted by federal, state and/or local law. If applicable and allowed by law, I will receive separate written notification regarding the Company's intent to obtain "consumer reports." I authorize and consent to, without reservation, any party or agency contacted by this employer to furnish the above-mentioned information. I hereby release, discharge, and hold harmless, to the extent permitted by federal, state, and local law, any party delivering information to the Company or its duly authorized representative pursuant to this authorization from any liability, claims, charges, or causes of action which I may have as a result of the delivery or disclosure of the above requested information. I hereby release from liability the Company and its representative for seeking such information and all other persons, corporations, or organizations furnishing such information. Further, if hired, I authorize the company to provide truthful information concerning my employment to future employers and hold the company harmless for providing such information. If hired by this Company, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. I also understand this Company employs only individuals who are legally eligible to work in the United States.

THIS APPLICATION WILL BE CONSIDERED ACTIVE FOR A MAXIMUM OF SIXTY (60) DAYS. IF YOU WISH TO BE CONSIDERED FOR EMPLOYMENT AFTER THAT TIME, YOU MUST REAPPLY. I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE, ACCURATE, AND COMPLETE. DO NOT SIGN UNTIL YOU HAVE READ ALL OF THE INFORMATION CONTAINED IN THE APPLICATION.

Applicant Signature

Clear

Date

If the applicant is a minor, the foregoing release and consent must be signed by the applicant's parent or legal guardian. Signature by the applicant's parent or legal guardian constitutes acknowledgement by the applicant and the parent or legal guardian that the Company, to the extent permitted by federal, state, and local law, can test the applicant for illegal or controlled substances, conduct inspections of property without notice, and communicate test results to Company personnel who need to know, the applicant, and the applicant's legal guardian.

Parent/Legal Guardian Signature

Clear

Witness Signature

Clear

Date

ESI Total Fuel Management Job Application

Education

Work Experience

Work Experience

Work Related References

Personal References

Driving Information

Traffic Violations

APPLICANT CERTIFICATION

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