Next Phase Environmental

Job Application Form

I am 18 years of age or older Yes

What type of employment are you seeking? (check all that apply) Full-timePart-timeTemporary

If hired, I can furnish proof that I am eligible to work in the U.S. Yes

Current Address
Previous Address

Have you ever Applied with Next Phase Environmental before? YesNo
Have you ever Worked for Next Phase Environmental before? YesNo
Tell us more about your past work experience with us:

Have you ever been convicted of any law violation? (Include any plea of "guilty" or "no contest". Exclude minor traffic violations.) YesNo
(A conviction will not necessarily disqualify an applicant from employment.)


College / University
Trade School
High School Did you graduate? YesNo


What skills or additional training do you have that are related to the job for which you are applying?
What machines or equipment can you operate that are realted to the job for which you are applying?

Do you have a valid drivers license? YesNo
Have you had your D.L. suspended or revoked in the last 3 years? YesNo


Job 1

Job 2

Job 3

Job 4

Are you presently employed? YesNo
If yes, whom do you suggest we contact?
If yes, please explain:


An Equal Opportunity Employer

We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors. Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Affidavit, Consent and Release

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I authorize the investigation of any or all statements contained in this application. I also authorize, whether listed or not, any person, school, current employer, past employers, and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements. I understand I will be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment. I understand that if I am extended an offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. I UNDERSTAND THAT THIS APPLICATION, VERBAL STATEMENTS BY MANAGEMENT, OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE AN EXPRESS OR IMPLIED CONTRACT OF EMPLOYMENT NOR GUARANTEED EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. ONLY THE PRESIDENT OF THE ORGANIZATION HAS THE AUTHORITY TO ENTER INTO AN AGREEMENT OF EMPLOYMENT FOR ANY SPECIFIED PERIOD AND SUCH AGREEMENT MUST BE IN WRITING, SIGNED BY THE PRESIDENT AND THE EMPLOYEE. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT REASON AND WITH OR WITHOUT NOTICE.

Affirmative Action Information

It is the policy of the organization to provide equal employment opportunity to all qualified applicants for employment without regard to race, color, religion, national origin, sex, age, veteran status or disability. As an affirmative action employer under E.O. 11246 we invite all applicants to identify themselves as indicated below. COMPLETION OF THIS FORM IS VOLUNTARY AND IN NO WAY AFFECTS THE DECISION REGARDING YOUR APPLICATION FOR EMPLOYMNT. THIS FORM IS CONFIDENTIAL AND WILL BE MAINTAINED SEPARATELY FROM YOUR APPLICATION FORM.

OPTIONAL - Racial Origin (You may mark one or more of the following).
WhiteAmerican Indian or Alaska NativeBlack or African AmericanAsianNative Hawaiian or Other Pacific IslanderHispanic or Latino

Gender MaleFemaleI elect not to identify

I have read, understand, and by my signature consent to the above statements.