Employment PERSONAL INFORMATIONName (First, Middle, Last)* First Middle Last Phone Number*Email Address* Enter Email Confirm Email Your Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are You Eligible to Work in The United States?* Yes No In order to work at Utility Cost Solutions you must be a citizen of the United States, or a permanent legal resident of the United States or have a current U.S. work visa.Have You Ever Been Convicted of a Felony?* Yes No If you answered Yes to a felony, please explain: Have you previously applied for a position at Utility Cost Solutions?* Yes No If you answered Yes to working at Utility Cost Solutions previously, please explain and add dates from and to: AVAILABILITYAre you seeking this position as Full Time primary employment or secondary Part-Time employment? Full Time Part Time How many hours per week are you looking to work? <10 10-20 20-30 30-40 40+ EDUCATIONList your educational experience beginning with the most current: Currently Enrolled Name Of School Major|Diploma Graduation Date Name Of School Major|Diploma Graduation Date Name Of School Major|Diploma Graduation Date Skills and Qualifications: Licenses, Training, AwardsPlease list any and all bail bonding experience you have that would make you a good candidate for this position:Please list any leadership, managerial or shift lead experience you have:YOUR EMPLOYMENT HISTORY Please list your present employer firstMay we contact your present employer? Yes No Employer Address Telephone Supervisor Date From DD slash MM slash YYYY Date To: Starting Wage: Ending Wage: Responsibilities Reason For Leaving: Employer Address Telephone Supervisor Date From: Date To: Starting Wage: Ending Wage: Responsibilities Reason For Leaving: Employer Address Telephone Supervisor Date From: Date To: Starting Wage: Ending Wage: Responsibilities Reason For Leaving: REFERENCESName Occupation Phone Address Name Occupation Phone Address Name Occupation Phone Address I certify that information contained in this application is true and complete.* I understand that false information may be grounds for not hiring me or for my immediate termination of employment any point in the future if I am hired. I authorize the verification of any or all information listed above. Δ
