Employment

Please complete all sections of this application. Fields marked with * are required. The more detail you provide, the better we can match you to the right position.

Equal Employment Opportunity: Newcomb Septic and Grading Company is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age, disability, genetic information, veteran status, or any other status protected by federal, state, or local law. All qualified applicants will receive consideration for employment.

1. Personal Information

Tell us about yourself. We do not ask for your Social Security number on this application — that is collected only after a job offer, for I-9 verification.

First Name *

Last Name *

Middle Initial

Date of Birth *

Street Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

How did you hear about us?

2. Position Desired

Select the role you are applying for. If you don't see it listed, choose "Other" and tell us what you're looking for.

Position Applying For *

If "Other," please specify:

Wage / Salary Expected

4. Education

List your highest level of education completed and any trade or vocational training.

Highest Grade / Degree Completed *

Year Completed

High School / GED

School Name & Location

Diploma / GED?

Year Completed

College / Trade School (optional)

School Name & Location

Degree / Certificate

Year Completed

5. Employment History

List your most recent jobs first. Include at least your last two employers. Account for all gaps in employment.

Employer 1 — Most Recent

Employer / Company Name *

Phone Number

Address

Your Job Title *

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Duties Performed

Reason for Leaving

May we contact this employer?

Yes

After job offer

Employer 2

Employer / Company Name

Phone Number

Address

Your Job Title

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Duties Performed

Reason for Leaving

May we contact this employer?

Yes

After job offer

Employer 3 (optional)

Employer / Company Name

Phone Number

Address

Your Job Title

Supervisor Name

Start Date

End Date

Starting Pay

Ending Pay

Duties Performed

Reason for Leaving

May we contact this employer?

Yes

After job offer

Employment Gap Explanation (if any)

6. References

Provide at least two professional references who are not family members and have not been listed as supervisors above.

Reference 1 *

Full Name *

Relationship

Phone Number *

Years Known

Reference 2 *

Full Name *

Relationship

Phone Number *

Years Known

Reference 3 (optional)

Full Name

Relationship

Phone Number

Years Known

8. Military Service (Optional)

Have you served in the U.S. Armed Forces?

Branch of Service

Rank at Discharge

Years of Service

Relevant military training or skills:

9. Criminal History

Please read carefully: A conviction will not automatically disqualify you from employment. We consider the nature and date of the offense, the position you are applying for, and your work history. Do not include arrests that did not result in a conviction, or any records that have been expunged or sealed.

Have you ever been convicted of a felony or misdemeanor? *

Yes

If yes, please describe (date, nature of offense, disposition):

Are there any pending charges against you?

Yes

10. Authorization & Certification

Applicant Certification & Agreement:

I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that any false statement, omission, or misrepresentation on this application may result in disqualification from consideration for employment or, if hired, may result in immediate dismissal, regardless of when the false information is discovered.

I authorize Newcomb Septic and Grading Company to investigate my background, including but not limited to my employment history, education, references, driving record, and criminal history (where permitted by law). I release all individuals and organizations from any liability for providing information in connection with such an investigation.

At-Will Employment Acknowledgment: I understand that if employed, my employment will be on an at-will basis, meaning either I or Newcomb Septic and Grading Company may terminate the employment relationship at any time, with or without cause or notice. I understand that no representative of the company other than the owner has the authority to enter into any employment agreement for a specified period or to make any agreement contrary to the at-will relationship, and that any such agreement must be in writing and signed by the owner.

I understand this application remains active for 60 days. If I am not hired within that period and still wish to be considered, I must submit a new application.

Applicant Signature (type full name as electronic signature) *

By typing my name above, I certify that I have read and agree to the terms stated above.

Today's Date *

By submitting, you certify that all information provided is accurate to the best of your knowledge.

NEWCOMB SEPTIC SERVICES

1. Personal Information

2. Position Desired

3. Availability

4. Education

5. Employment History

6. References

7. Skills Relevant to Septic & Grading Work

8. Military Service (Optional)

9. Criminal History

10. Authorization & Certification

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