INSTRUCTIONS

Please answer all questions. Applications that are not complete may not be considered. If space is not sufficient for complete answers or you wish to furnish additional information such as a resume or cover letter, please send by email. Please do not send confidential information such as your social security number and birthdate. This information is not necessary until after a position has been offered. If you have questions, please send them by email.

APPLICANT INFORMATION

Last Name

First Name

M.I.

Date

Street Address

Apartment/Unit #

City

State

ZIP

Home Phone

Other

Email Address

Date Available

Desired Salary

Position Applied for

Are you currently employed?

YES NO

If yes, may we contact your current employer?

YES NO

Are you over the age of eighteen?

YES NO

If no, hire is subject to verification that you are of minimum legal age to work.

Are you authorized to work in the United States?

YES NO

Have you ever worked for Southland,CSI or CHELCO?

YES NO

If so, when?

Are you related to any current employees of Southland or CHELCO?

YES NO

If so, who and how

Certain relatives of a Southland employee may not be hired per Southland policy.

Have you been convicted of a crime in the past five (5) years?

YES NO

If yes, explain

Have you ever had a criminal record or an arrest record sealed or expunged?

YES NO

If yes, explain

EDUCATION

High School

Address

Did you graduate?

YES NO

Degree

College

Address

From:

To:

Did you graduate?

YES NO

Degree

Other

Address

From:

To:

Did you graduate?

YES NO

Degree

SPECIALIZED SKILLS

Computer Skills:

Equipment Skills:

Certifications:

WPM:

Second Language:

Additional skills/qualifications:

DRIVING HISTORY

Do you have a valid driver's license and/or CDL?

YES NO

Date of Expiration:

License Number:

License Class:

EMPLOYMENT HISTORY ( Please list present and past 3 employment, beginning with most recent )

Company

Phone

Address

Supervisor

Job Title

Starting Salary $

Ending Salary $

Responsibilities

Laborer Foreman Supervisor

From:

To:

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Add More +

Have you ever been dismissed or asked to resign or had any disciplinary action taken against you from any employment or position you have held?

YES NO

Have you resigned, or left a job by mutual agreement following allegations of misconduct or unsatisfactory job performance?

YES NO

I certify that my 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 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 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 in my application or interview(s) may result in termination. I understand, also, that I am required to abide by all rules and regulations of the employer.

Signature

Date

FOR OUR INFORMATION

How were you made aware of this position?

Southland Website

Employ Florida

Friend

Relative

Media

Others

TO APPLICANT: Thank you for taking the time to complete this application. We appreciate your interest in our organization. After your application has been reviewed by the hiring supervisor, you will either receive a phone call requesting to schedule an interview, or a letter notifying you that you have not been selected for the position that you applied for. If you are interested in applying for another open position you will need to complete and submit a new application. We consider applicants for all positions without regard to race, religion, creed, gender, national origin, age, disability, marital status, or veteran status, or any other legally protected status.

Southland Utility Services, Inc.

Online Employment Application

INSTRUCTIONS

APPLICANT INFORMATION

EDUCATION

SPECIALIZED SKILLS

DRIVING HISTORY

EMPLOYMENT HISTORY ( Please list present and past 3 employment, beginning with most recent )

FOR OUR INFORMATION