Application for Employment
(* fields marked with asterisk are required)		  
Full Name (first, middle initial, last):*    
Area code and phone : * (numbers only - do not use spaces or hyphens)            Email Address:
Home Address: *        City:*         State: *        Zip Code: *
Position you are applying for: *             Expected salary:  $ (do not use $ symbol)
How did you hear about Merico?: *         Please specify source: *
Are you at least 18 years old?*  Yes No                   If under 18, can you furnish a work permit?*    Yes No
Are you a citizen or an alien lawfully authorized to work in the U.S.?*   Yes No
With accommodation, can you perform the essential function of the job?  Yes No
Have you ever been convicted of a felony?  Yes No
 If so, state offense, date, and location:
Have you ever been employed by m-Optic, Gregg Industrial Insulators, Merico Abatement Contractors, or Merritt Safety?*
   Yes No
If so, what was your position:*               Date(s) of hire:*
                                                               (Please replace default text with your position / hire dates if needed)
 
EDUCATION
Name of school City, State Dates attended
from --- to		 Did you graduate? Degree / major
High School:*
 		* * *  
College/University:
Other:
 
REFERENCES
Name & Occupation Relationship Address & Telephone
 
TO OUR APPLICANT:  We appreciate your interest in seeking employment with Merico Abatement and assure you that we are sincerely
 interested in pursuing your application for employment.  A clear understanding of your skills and work history will aid us in
considering you for the position for which you are applying.  Merico Abatement considers applications for all positions without regard to
race, color, religion, sex, national origin, age, marital or veteran status, disability, or any other legally protected status.
 
Please indicate the days and times you are available to work:   (use format "8am-5pm" or "no" if not available that day)
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
* * * * * * *
 
EMPLOYMENT HISTORY
Beginning with your present or most recent position, list your last three jobs.  Please note any full or part-time employment and periods of unemployment. Please indicate the reason for any length of unemployment between present application date and most recent position
May we contact your present employer for a reference?  Yes No
May we contact you at your business?Yes No
 If yes, please enter your telephone number:   (do not use spaces or hyphens)
 
Employer 1
Present or most recent employer:      Telephone number: (do not use spaces or hyphens)
Address:                       City, State:
Starting date:          Ending date:                Hours per week: 
Beginning pay:  $ (do not use $ symbol)        Final pay:  $(do not use $ symbol)   
Supervisor:  
Reason for leaving:        Your full name if different:  
Job title and duties:
 
Employer 2
Employer name:            Telephone number: (do not use spaces or hyphens)
Address:                         City, State:
Starting date:             Ending date:                  Hours per week:
Beginning pay:  $ (do not use $ symbol)           Final pay:  $ (do not use $ symbol)
Supervisor:
Reason for leaving:           Your full name if different:
Job title and duties:
 
Employer 3
Employer name:              Telephone number: (do not use spaces or hyphens)
Address:                          City, State:
Starting date:               Ending date:                    Hours per week:
Beginning pay: $ (do not use $ symbol)           Final pay: $  (do not use $ symbol)      
Supervisor:
Reason for leaving:         Your full name if different:
Job title and duties:
                    Have you checked over your application for completeness? Yes, I have checked it.