Employment

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Baxter Group, Inc. is an Equal Opportunity and Affirmative Action Employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, veteran status, sexual orientation, or any other legally protected status

Date(Required)

Position Applied For:(Required)

How did you hear about us?

Applicant Name(Required)

First Middle Last

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you lived at your current address?(Required)

Date of Birth(Required)

Social Security Number(Required)

Phone Number(Required)

Email Address(Required)

Previous Three Years Residency

Address #1

Street Address City State / Province / Region ZIP / Postal Code

# Years

Address #2

Street Address City State / Province / Region ZIP / Postal Code

# Years

Address #3

Street Address City State / Province / Region ZIP / Postal Code

# Years

If you are under 18 years of age, can you provide required proof of your eligibility to work?(Required)

Yes

No

Have you submitted an employment application with us before?(Required)

Yes

No

If YES, please list date:

Have you been previously employed with us before?(Required)

Yes

No

If YES, please list date:

Are you currently employed?(Required)

Yes

No

If YES, may we contact your current employer?

Yes

No

N/A

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?(Required)

Yes

No

(Proof of citizenship or immigration status will be required upon employment.)

Date available for work(Required)

Desired employment status(Required)

Full Time

Part Time

Are you currently on "lay-off" status and subject to recall?(Required)

Yes

No

Can you travel if a job requires it?(Required)

Yes

No

Have you EVER plead guilty to, or been convicted of a felony?(Required)

Yes

No

(Conviction will not necessarily disqualify an applicant from employment.)

If YES, Please Explain:

Baxter Group, Inc. is a drug free workplace. Are you able to pass a drug test today?(Required)

Yes

No

Are you physically able to carry out all necessary job assignments/functions and perform them in a safe manner?(Required)

Yes

No

Do you suffer from mold or any allergies?(Required)

Yes

No

Please list all allergies:

Education

High School

Name and Address of School

Course of Study

Years Completed

Diploma Degree

Undergraduate College

Name and Address of School

Course of Study

Years Completed

Diploma Degree

Graduate Professional

Name and Address of School

Course of Study

Years Completed

Diploma Degree

Other

Name and Address of School

Course of Study

Years Completed

Diploma Degree

Additional Information

Indicate any foreign languages you can fluently speak, read and/or write:

Describe any professional, trade, or business specialized training, apprenticeship, or skills you may have or any participation in civic activities or offices you may have held:

Describe any job-related training you may have received while serving in the United States military:

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer #1 Name

Address

Supervisor Name

Phone

Position Held

Start Date

Starting Pay

End Date

Ending Pay

Reasons for leaving

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON:

Employer #2 Name

Address

Supervisor Name

Phone

Position Held

Start Date

Starting Pay

End Date

Ending Pay

Reasons for leaving

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON:

Employer #3 Name

Address

Supervisor Name

Phone

Position Held

Start Date

Starting Pay

End Date

Ending Pay

Reasons for Leaving

ANY GAPS IN EMPLOYMENT AND/OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH/YEAR) AND REASON:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by any of the above previous employers?(Required)

Yes

No

If YES, which employer?

Were any of the previous job positions listed above designated as a safety sensitive function in any DOT regulated mode, subject to alcohol and controlled substances testing requirements as required by 49 CFR Part 40?(Required)

Yes

No

If YES, which employer?

References

1. Full Name

Phone

Relationship to Applicant

2. Full Name

Phone

Relationship to Applicant

3. Full Name

Phone

Relationship to Applicant

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I authorize Baxter Group, Inc. to perform all necessary background and record checks, including, but not limited to: criminal records, child abuse history clearance, federal criminal record reports and my drivers record history. This application for employment shall be considered active for a period of not to exceed 45 days. Any applicant wishing to be considered for employment beyond this period should inquire as to if applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Employer. (NOTE: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.)

Applicant's Signature

Date

Employment Application

Previous Three Years Residency

DRIVER’S LICENSE INFORMATION

Driving Experience

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE

TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 3 YEARS, OTHER THAN PARKING VIOLATIONS

Education

Additional Information

Employment Experience

References

Applicant's Statement

Baxter Environmental Group, Inc.

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