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Dynaserv Industries Application for Employment

We are an Equal Opportunity Employer. All persons shall have the opportunity to be considered for employment without regard to their race, color, creed, religion, national origin, ancestry, citizenship status, age, disability, sex, sexual orientation, veteran status, genetic information or any other characteristic protected by applicable federal, state or local laws. We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please let us know.
Applicant Name *
Applicant Name
Address *
Address
Phone (Primary) *
Phone (Primary)
Phone (Secondary)
Phone (Secondary)
Are You 18 Years Old or Older? *
Are You Legally Eligible for Employment in the USA? *
Pursuant to the Immigration Reform and Control Act of 1986, all applicants who are offered employment must produce documents establishing their identity and authorization for employment in the United States. These documents must be produced no later than three (3) business days after employment commences. In addition, all new hires will be required to verify their employment authorization under oath by signing INS Form I-9 commencing employment.
EDUCATION
Name / Location of School / Course of Study
Name / Location of School / Course of Study
Name / Location of School / Course of Study
EMPLOYMENT HISTORY
List your last three employers, starting with the most recent.
Company Phone *
Company Phone
Employed Beginning *
Employed Beginning
Employment Ending *
Employment Ending
Company Phone
Company Phone
Employment Beginning
Employment Beginning
Employment Ending
Employment Ending
Company Phone
Company Phone
Employment Beginning
Employment Beginning
Employment Ending
Employment Ending
SKILLS & QUALIFICATIONS
Summarize any special training, skills, licenses, and/or certifications that may assist you in performing the position for which you are applying.
Do you currently have a valid driver license that allows you to operate a motor vehicle in New York State?
Please also list your number of years with a license and number of years with driving experience
REFERENCES
Provide names of three persons not related to you, whom you have known at least one year. Please exclude former employers.
Phone *
Phone
Phone *
Phone
Phone *
Phone
MOTOR VEHICLE RECORD CONSENT AGREEMENT
BY CHECKING YES BELOW, YOU AUTHORIZE DYNASERV INDUSTRIES TO OBTAIN YOUR DRIVING RECORD FOR EMPLOYMENT. PLEASE NOTE THAT IF YOUR DMV RECORD PASSED THE COMPANY'S REQUIREMENTS AND AN OFFER OF EMPLOYMENT IS MADE, IT WILL BE PENDING A FULL BACKGROUND CHECK. SHOULD ANY DISCREPANCIES OR INCONSISTENCIES ARISE, EMPLOYMENT MAY BE TERMINATED.
*
Date of Birth *
Date of Birth
“I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s lawful rules and regulations, and I agree that I may resign my employment and my employment may be terminated, with or without cause, and with or without notice, at any time. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than the CEO or COO, and then only in writing, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.”
Please type name
Today's Date *
Today's Date