General Application

First Name*

Last Name*

Email*

A valid email address is required.

Telephone Number*

A valid phone number is required.

Alternate number

A valid phone number is required.

Address Line1*

Address Line2

City*

State*

Zip*

Position for which you are applying*

Other positions you are interested in

Date available for work*

Expected Salary $*

Per*

Schedule you are available to work*

Are you legally eligible to work in the United States?*

Are you presently employed?*

How were you referred to our company?*

Do you have any relatives employed by our company?*

Have you ever applied for a position with our company?*

Current Employer

Employer Name

Address

Job Title

Start Date

Salary

Reason for leaving

May we contact your current employer for a professional reference?

Previous Employer 1

Previous Employer 1 Name*

Previous Employer 1 Address*

Previous Employer 1 Job Title*

Previous Employer 1 Start Date*

Previous Employer 1 End Date*

Previous Employer 1 Salary

Previous Employer 1 Reason for Leaving*

Previous Employer 2

Previous Employer 2 Name*

Previous Employer 2 Address*

Previous Employer 2 Salary

Previous Employer 2 Start Date*

Previous Employer 2 End Date*

Previous Employer 2 Job Title*

Previous Employer 2 Reason for Leaving*

Education Record 1

School 1 Name

School 1 Start Date

School 1 End Date

School 1 Level

School 1 Degree / Major

School 1 Graduated?

School 1 Activities / Honors

Education Record 2

School 2 Name

School 2 Start Date

School 2 End Date

School 2 Level

School 2 Degree / Major

School 2 Graduated?

School 2 Activities / Honors

Professional Reference 1

Professional Reference 1 Name*

Professional Reference 1 Company*

Professional Reference 1 Title*

Professional Reference 1 Relationship at time of employment*

Professional Reference 1 Telephone*

A valid phone number is required.

Professional Reference 1 Email Address

Professional Reference 1 Years Known*

Professional Reference 2

Professional Reference 2 Name*

Professional Reference 2 Company*

Professional Reference 2 Title*

Professional Reference 2 Relationship at time of employment*

Professional Reference 2 Telephone*

A valid phone number is required.

Professional Reference 2 Email Address

Professional Reference 2 Years Known*

Professional Reference 3

Professional Reference 3 Name*

Professional Reference 3 Company*

Professional Reference 3 Title*

Professional Reference 3 Relationship at time of employment*

Professional Reference 3 Telephone*

A valid phone number is required.

Professional Reference 3 Email Address

Professional Reference 3 Years Known*

Additional Information: If the position you are applying for requires driving for the company, please fill in the information below. If the position you are applying for does not require driving for the company, please enter N/A and proceed to the next question.

Driver's License Number*

Expiration Date*

Driver's License State*

Has your license ever been suspended or revoked?*

If Yes, please give a brief explanation. If not applicable, enter N/A and proceed to the next question*

Are you willing to submit to a post-offer drug/alcohol screen and physical exam (where applicable), as a condition of employment with Energy Management Corporation?*

Please list any professional skills and/or certification information that may assist us in our selection process

All applications that have been completed in full will be reviewed. If your skill set matches the qualifications required for the position you've applied for, you will be contacted by a member of our team.

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by Human Resources Department or a member of the Executive Team.

Gender

Race / Ethnicity

Hispanic or Latino – A person of Cuban; Mexican; Puerto Rican; South or Central American; or other Spanish culture or origin regardless of race. White (Not Hispanic or Latin o ) – A person having origins in any of the original peoples of Europe; the Middle East or North Africa. Black or African American (Not Hispanic or Lati n o ) – A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Lat i n o ) – A person having origins in any of the peoples of Hawaii; Guam; Samoa or other Pacific Islands. Asian (Not Hispanic or Latin o ) – 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 and Vietnam. 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 maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latin o ) – All persons who identify with more than one of the above five races.

We are an equal opportunity employer. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status, or any other protected Federal, State/Province, or Local status unrelated to the performance of the work involved.

Please check any definitions that apply to you.

Do you have military experience?

Vetran Status

Disabled Veteran: (i) a veteran of the U.S. military; ground; naval; or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or (ii) a person who was discharged or released from active duty because of a service/connected disability. Armed Forces Service Medal Veteran: a veteran who; while serving on active duty in the U.S. military; ground; naval or air service; participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985. Recently Separated Veteran: a veteran during the three-year period beginning on the date of such veteran’s discharge or release from active duty in the U.S. military; ground; naval or air service from when you were hired. Special Disabled Veteran: (i) a veteran of the U.S. military; ground; naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veterans’ Affairs for a disability (A) rated at 30 percent or more; or (B) rated at 10 or 20 percent in the case of a veteran who has been determined under Section 38 U.S.C. 3106 to have a serious employment handicap or (ii) a person who was discharged or released from active duty because of a service-connected disability. Veteran of the Vietnam-era: a person who: (i) served on active duty in the U.S. military ground; naval or air service for a period of more than 180 days; and who was discharged or released there from with other than a dishonorable discharge; if any part of such active duty was performed: (A) in the Republic of Vietnam between February 28; 1961; and May 7; 1975; or (B) between August 5; 1964; and May 7; 1975; in all other cases; or (ii) was discharged or released from active duty in the U.S. military; ground; naval or air service for a service-connected disability if any part of such active duty was performed (A) in the Republic of Vietnam between February 28; 1961; and May 7; 1975; or (B) between August 5; 1964; and May 7; 1975; in any other location. Other Protected Veterans: veterans who served on active duty in the U.S. military; ground; naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.

Terms and Signature

Terms*

I Accept and Understand: All information provided by me is true and correct to the best of my knowledge. I understand omissions or misrepresentations may result in rejection of my application or; if employed; may result in subsequent dismissal. I understand and agree that background inquiries may be requested by you or on your behalf that will seek information as to my character; work habits; including oral assessments of my job performance; experiences and abilities; along with reasons for termination of past employment. Furthermore; I understand and agree that you may request information from various federal; state; and other agencies; including public and private sources which maintain records concerning my past activities relating to my driving record; credit history; criminal record; civil matters; previous employment; educational background; and other past experiences. I acknowledge that EMC participates in E-verify to determine the eligibility of their employees to work in the United States. I acknowledge that a telephonic facsimile; email; or copy of this release shall be as valid as the original. This release is valid for all federal; state; county and local agencies and authorities. I understand this is a preliminary application and not a contract to employ me. Furthermore; in the event I am employed; my employment shall be completely voluntary and may be terminated at will at any time by either myself or the company. I understand that no one other than the company president has authority to enter into any employment agreement to the contrary. I agree to take a job-related physical examination or a drug/alcohol test when requested as a condition of employment. I agree to comply with all rules of the company as a condition of employment. In the event the company advances me money or other things of value; I agree to repay the company and also that any amount still owing may be deducted from my final paycheck. I DO NOT Accept

Applicant Signature (type name to sign)*

Attach Resume*