APPLICATION FOR EMPLOYMENT

Equal Opportunity Employer – Discrimination in employment because of race, religion, creed, color, national origin, ancestry, disability,
age, sex, or liability for service in the Armed Forces of the United States is prohibited by company policy. In addition, Efficient Systems,
Inc. is an equal opportunity employer.

Are you 18 years of age or older?YesNo

GENERAL INFORMATION

Have you ever been employed or applied at Efficient Systems, Inc.? YesNo

Have you ever pled guilty to or been convicted of a felony? YesNo

Are there any restrictions on days or hours you are available to work? YesNo

Are you seeking work: Full TimePart Time

Can you read from blueprints? YesNo
Have you ever been bonded? YesNo

Do you have a valid driver’s license? YesNo
Is a car available to you for daily use? YesNo

Have you ever received any driving citations in the last 24 months? YesNo

EDUCATION

School
Name and
Location
Years
Completed
Dates Attended
From
To
Major
Did you Graduate

Grade school

High school

College

Other

EMPLOYMENT HISTORY

(Most recent experience first – Include ALL employers for the past five years. Explain any gaps in employment.)

1.
Company:
Telephone:

Address:
Dates of Employment:

Wage:

Position:
Supervisor’s name:

Reason for leaving:
Title:

2.
Company:
Telephone:

Address:
Dates of Employment:

Wage:

Position:
Supervisor’s name:

Reason for leaving:
Title:

3.
Company:
Telephone:

Address:
Dates of Employment:

Wage:

Position:
Supervisor’s name:

Reason for leaving:
Title:

4.
Company:
Telephone:

Address:
Dates of Employment:

Wage:

Position:
Supervisor’s name:

Reason for leaving:
Title:

May we contact the employers listed above?YesNo

PERSONAL REFERENCES

Name
Address
Telephone No.
Relationship
Years known

ADDITIONAL INFORMATION

Do you have any relative employed by Efficient Systems, Inc.?YesNo

Are you an U.S. citizen or an alien authorized to work in this country?YesNo
If you are offered employment with Efficient Systems, Inc., you will be required by federal law, to furnish documents showing you are either a U.S. citizen
or an authorized alien. Individuals who do not furnish these documents cannot work for Efficient Systems, Inc.

In exchange for the Company's consideration of my application for employment and in consideration of the Company's hiring of me if employment is offered and accepted, I do hereby waive and relinquish any right to a jury trial in any civil action or lawsuit brought by the undersigned against the Company including without implied limitation any action brought pursuant to Title VII of the Civil Rights Act of 1964, as amended and the Age Discrimination in Employment Act. I further acknowledge that I have fully read the application for employment and this waiver and totally understand them. I am voluntarily signing the waiver and swear or affirm that all statements and information contained in this waiver and in my application for employment are accurate and truthful. I further understand that this waiver is not in any way a contract of employment.

Signature:
Date:

I hereby authorize anyone of whom request is made to supply to Efficient Systems, Inc., any information concerning my background in connection with employment consideration. I hereby release all parties, including but not limited to Efficient Systems, Inc. and my prior employers, from any and all liability for any damage that may result from their furnishing information concerning me. I understand falsification, misrepresentation, incomplete information, or omission of facts called for on this application will result in dismissal.
I understand and hereby acknowledge that if I am offered and accept employment with Efficient Systems, Inc., my employment is considered at-will, is for no definite period of time, and may be terminated with or without cause. I understand that employment is subject to successful completion of a ninety (90) day probationary period, during which attendance, work habits and job performance are carefully scrutinized to determine whether employment should be continued. I further understand that this application for employment is not a contract of employment.

Signature:
Date:

If an opening occurs and you are qualified, we will be in touch with you.
We will be glad to give this record active consideration for a period of four weeks (please ask for explanation of procedure).

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