Employment Application

We consider applications for all positions without regard to race, color, religion, creed, national origin, disability, sexual orientation, citizenship status, or any other legally protected status.

Position(s) Applying for:*

How Did You Learn About Us?

Employment Agency
Relative
Friend
Inquiry
Online
Other

Please explain.

PERSONAL INFORMATION

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email

BACKGROUND INFO

Best time to contact you is: AM or PM*

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

YES
NO

Have you ever filed an application with us before?*

YES
NO

Approximate Date of Previous Application.

Have you ever been employed with us before?*

YES
NO

Approximate Date of Previous Employment.

Do any of your friends or relatives, other than spouse, work for Eastco?*

YES
NO

Name of friend/relative

First Name	Last Name

Are you currently employed?*

YES
NO

May we contact your present employer?*

YES
NO

In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.

Date Available to Work*

What is Your Salary Range?*

Are you available to work?*

Full Time
Part Time
Overnight
Temporary

Are you currently on lay-off status and subject to recall?*

YES
NO

Can you travel if a job requires it?*

YES
NO

Do you have any founded reports of child abuse or substantiated abuse?*

YES
NO

If yes, please explain:

EDUCATION

High School

Name / Location	Years Completed	Diploma: YES or NO

College

Name / Location	Course of Study	Years Completed	Diploma: YES or NO

Business or Trade School

Name / Location	Course of Study	Years Completed	Diploma: YES or NO

Professional or Graduate School

Name / Location	Course of Study	Years Completed	Diploma: YES or NO

Describe any specialized training, apprenticeship, skills and extra-curricular activities.

Did you serve in the United States military?*

Yes
No

Describe any job-related training received in the United States military.

WORK EXPERIENCE

Start with your present or last job. Include any job-related military service assignments and volunteer activities.

EMPLOYER 1

Name of Employer	City, State, ZIP	Phone Number

Name of Supervisor	Employment Dates	Reason for Leaving

Reason for leaving. Be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

EMPLOYER 2

Name of Employer	City, State, ZIP	Phone Number

Name of Supervisor	Employment Dates	Reason for Leaving

Reason for leaving. Be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

EMPLOYER 3

Name of Employer	City, State, ZIP	Phone Number

Name of Supervisor	Employment Dates	Reason for Leaving

Reason for leaving. Be specific.

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

REFERENCES

Please list below three persons not related to you who have knowledge of your work performance and/or personal qualifications within the last 5 years.

REFERENCE 1

Name	Occupation	Company Name	Address	Phone	Email	Years Acquainted

REFERENCE 2

Name	Occupation	Company Name	Address	Phone	Email	Years Acquainted

REFERENCE 3

Name	Occupation	Company Name	Address	Phone	Email	Years Acquainted

APPLICATION FORM WAIVER

After reading each paragraph closely, please check the box next to each paragraph.*

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any other document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize Eastco Diversified Services to thoroughly investigate my references, work records, education, driving record, credit history, criminal background and other matters related to my suitability for employment. I further authorize the employers, schools and other references I have listed to disclose to Eastco Diversifed Services any and all documents, transcripts, letters, reports and other information related to these references, without giving me prior notice of such disclosure.
I understand that nothing contained in the application, or conveyed during any interview which may be granted, or during my employment, if hired, is intended to create an employment contract between me and Eastco Diversified Services, other than one that is at will. I understand and agree that if I am employed, my employment will be of an at will nature, whereby either the employee or the employer may terminate the employment relationship at any time, with or without cause or notice. I further understand that my employment, if hired, is for no definite or determinable period of time and may be terminated at any time, at the option of either myself or Eastco Diversified Services, and that no promise or representation contrary to the foregoing is binding on the company unless made in writing and signed by me and the company's designated representative.

Type Name for Signature*

Date*

Online Employment Application

PERSONAL INFORMATION

BACKGROUND INFO

EDUCATION

WORK EXPERIENCE

REFERENCES

APPLICATION FORM WAIVER