Brewers Septic Services, INC


                                              Portable Toilet Rental and Service ~ Septic Tank Cleaning

BREWER'S SEPTIC SERVICES, INC.  ~ 1929 County Rd. 139 ~ Ovid NY 14521

                           607-869-5096         fax 607-869-5191



APPLICATION FOR EMPLOYMENT. 


Name __________________________________                   Date ________________

Address _________________________________________________________________

Telephone ______________________________                  SS#__________________

Position ________________________________                   Start date ___________

Expeted Salary / $hr. ___________________                    Full or Part time ( circle ) 


Have you worked with us before? If Yes, Explain job, Title and Duration: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Including traffic violatons, Have you ever been convicted of a crime?  Please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Do you have any physical handicap that would prevent you from driving or manual labor tyes of work?  If so please explain: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Education : 

Name / location of school        Grade completed    Did you graduate?     Degree 

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


EMPLOYMENT HISTORY - start with most recent work expereince and work back - 

comapny name   telepone   postion  date(to/from)  salary(pay rate) resaon leaving  

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

may we contact your previous employers?  YES    NO 


Please List Three References with Phone # and relationship - excluding family 

1__________________________________________________________________________

2__________________________________________________________________________

3___________________________________________________________________________


Can you drive standard transmission?    YES    NO


Federal and state law requires that all applications be considered without regard to race, religion, color, sex, age or natinal orgin.  We believe in and fully support the principal of equal employment opportunity and will fulfill our obligatin to the fullest.  I acknowledge that if I am hired, I will be an at-will employee.  I will be subject to dismissal or discipline without notice or cause, at the discretion of the employer.  I also understand that I am free to quit my employment at any time for any reason, without notice.  The statements I have made in this application are true and complete.  I understand that if I am hired, any false or incomplete statements will be grounds for immediate discharge. 

APPLICANT'S SIGNATURE 

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