Form - Application for Employment

Personal Information - Pre-Employment Questionnaire, An Equal Opportunity Employer

    (example: 952-555-1212)

Desired Employment


Ever applied to Enviromatic before?


Ever worked for Enviromatic before?



High School
Other Education


Below give the names of three persons you are not related to whom you have known at least one year.
Name, Phone # and how you know your reference:

Service Record

Do you have a valid drivers license?

Do you have any major violations?
(a Valid Drivers License is Required, and Driver Must Pass Review by Our Insurance Company)
Former Employers. List below all previous employers starting with the most recent first.

1. Employment


2. Employment


3. Employment


4. Employment


5. Employment



"I certify that the facts contained in this application are true and complete 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 above 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 to the following:
1. That no representative of the company 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, unless it is in writing and signed by an authorized company representative.
2. That if offered a job a social security number will be required for a background check and to verify eligibility.
3. That if offered a job it will be contingent on passing a criminal background check.
4. That an employee may be terminated for providing falsified or misleading statements on this application.
5. That if I am hired by Enviromatic, my employment will be at will. If I am hired, either I or my employer can terminate my employment at any time, with or without notice, and for any lawful reason."