NuGen Energy, LLC - Employment Application

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Employment Application

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Work Phone

Email

Will you work overtime if asked

Yes

No

Are you at least 18 years of age?

Yes

No

Are you a Veteran of U.S. Military Service?

Yes

No

Are you legally able to be employed in the USA?

Yes

No

If not a US citizen, current Visa or Immigration Status

Were you ever previously employed by this company?

Yes

No

If "Yes", When?

Have you been convicted of a misdemeanor or felony?

Yes

No

If "Yes", please explain

What date are you available to start?

What position are you applying for?

Education

What is the highest degree you have completed/obtained?

High School

Associates Degree

Bachelors Degree

Doctorate Degree

Masters Degree

Some College

Describe course of study/major

Describe specialized training, apprenticeship, skills and extra curricular activities

Special Skills and Qualifications

Summarize special skills and qualifications acquired from employment or other experience:

List professional, trade, business or civic activities and offices held.

Employment

Employer 1 Information

Employer Name

Street Address

City

State

Zip Code

Work Phone

Job Title

Name of Supervisor

Description of Duties

Dates Employed (From/To)

Reason For Leaving?

Hourly Rate/Salary

Employer 2 Information

Employer Name

Street Address

City

State

Zip Code

Work Phone

Job Title

Name of Supervisor

Description of Duties

Dates Employed (From/To)

Reason For Leaving?

Hourly Rate/Salary

Employer 3 Information

Employer Name

Street Address

City

State

Zip Code

Work Phone

Job Title

Name of Supervisor

Description of Duties

Dates Employed (From/To)

Reason For Leaving?

Hourly Rate/Salary

References

Reference 1 Information

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Reference 2 Information

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Reference 3 Information

First Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Required field

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