APPLICATION FOR EMPLOYMENT POWER CLEAN LLC
PRE-EMPLOYMENT QUESTIONNAIRE, EQUAL OPPORTUNITY EMPLOYER 1733 MARYVILLE PIKE
KNOXVILLE, TN 37920
865-573-4114 OFFICE
865-573-4113 FAX
PERSONAL INFORMATION DATE 
                   
NAME (LAST NAME FIRST)    SSN:  
       
CURRENT ADDRESS     CITY   STATE   ZIP CODE  
   
PERMANENT ADDRESS   CITY   STATE   ZIP CODE  
   
PHONE NO.     E-MAIL ADDRESS REFERRED BY  
   
DRIVERS LICENSE NO.     ISSUING STATE EXP DATE  
       
EMPLOYMENT DESIRED
                   
POSITION   DATE YOU CAN START SALARY DESIRED  
    $  
ARE YOU CURRENTLY EMPLOYED? IF SO, MAY WE CONTACT YOUR CURRENT EMPLOYER?
YES NO
   YES NO        
HAVE YOU APPLIED WITH US BEFORE? WHERE?     WHEN?    
YES NO
      
EDUCATION HISTORY
                   
NAME & LOCATION OF SCHOOL YEARS ATTENDED GRADUATED? COURSES STUDIED
GRAMMAR SCHOOL              
YES NO
HIGH SCHOOL              
YES NO
COLLEGE              
YES NO
TRADE, BUSINESS, CORR. SCHOOL              
YES NO
GENERAL INFORMATION
                   
SPECIAL SKILLS, TRAINING AND OR SUBJECTS OF SPECIAL STUDY (One per line)  
                   
US MILITARY OR NAVAL SERVICE   RANK    
       
FORMER EMPLOYERS (LIST BELOW LAST FOUR EMPLOYERS, STARTING WITH LAST ONE FIRST)
                   
DATE, MONTH & YEAR
(mm/dd/yyyy)		 NAME & ADDRESS OF EMPLOYER SALARY POSITION REASON FOR LEAVING
FROM   $
TO                
FROM   $
TO                
FROM   $
TO                
FROM   $
TO                
REFERENCES (BELOW LIST THREE PERSONS WITH NO RELATION, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR)
                   
NAME ADDRESS BUSINESS YRS KNOWN
     
                   
     
                   
     
                   
RESUME
Please copy and paste your resume into the field below:
 
AUTHORIZATION
By pressing the button below, I certify that the facts contained in this application are true and I have completed to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.  I authorize investigation of all statements contained herein and the references and employers listed ablove to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.  I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.  This waiver does not permit the release or use of disability-related information in a manner prohibited by the Americans with Disabilities Act (ADA) and other federal and state laws.