Personal Information

Position You are Applying For*

Please List Your Current Salary Requirements*

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Are you 18 years or older?*

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Are you either a U.S. citizen or an alien authorized to work in the United States?*

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Are you currently employed?*

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Who referred you to National Waste Associates, LLC?

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Educational Information

High School Name

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High School: Graduate?

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College Name

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College: Number Of Years Attended

College: Graduate?

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Trade Or Business School: Graduate?

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Work History and Employment Details

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Last Salary HIDDEN

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Professional References (other than relatives)

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Name	Relationship to Applicant	Phone	Company	Years Known

Do you have a family member or friend currently active/working in any capacity in the waste and recycling industry?

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Please provide the information below.

Name	Relationship	Job Title	Company

Drug And Alcohol Screening

*** I UNDERSTAND THAT IF I AM A QUALIFIED CANDIDATE FOR A JOB OPENING, I WILL BE REQUIRED TO UNDERGO A DRUG AND ALCOLHOL SCREENING WITH A SUBSEQUENT NEGATIVE RESULT AS A CONDITION OF EMPLOYMENT. THE SIGNING OF THIS FORM IS MY PERMISSION FOR NATIONAL WASTE ASSOCIATES, LLC OR IT’S AGENT TO TAKE SAMPLES OF MY URINE AND PERFORM A DRUG SCREENING ON SUCH SAMPLES, AND TO TAKE SAMPLES OF MY BREATH AND PERFORM AN ALCOLHOL SCREENING ON SUCH SAMPLES. FURTHER, I GIVE MY CONSENT FOR THE RELEASE OF THE TEST RESULTS TO AUTHORIZED COMPANY MANAGEMENT FOR APPROPRIATE REVIEW. ***

Signature*

Date*

Authorization

*** 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 EMPLOYERS LISTED TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU. I UNDERSTAND AND AGREE THAT, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINTATED AT ANY TIME WITHOUT ANY PRIOR NOTICE. ***

Signature*

Date*

Application For Employment

Personal Information

Educational Information

Work History and Employment Details

Drug And Alcohol Screening

Authorization

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