Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Employer Information Elite Technician Management Group 2217 East Canal Street Picayune, Mississippi 39466 (985) 326-8192 It is the policy of Elite Technician Management Group to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status. Fill out completely. Do No Leave Blanks. Applicant Information Name *FirstMiddleLastHome Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDaytime Phone *Social Security NumberEvening Phone *Driver's License Number *Mobile Phone *Email *Emergency Contact Contact's Name *FirstLastRelationship to You *Contact's Phone Number *Contact's AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob Position Applied For *Full or Part Time? *Salary Desired *Per *Who referred you to our company? *Do you have any friends or relatives who work here? If yes, please list here: *Are you at least 18 years old? Yes/No *How will you get to work? *Are you willing to work any shift, including nights and weekends? If no, please state any limitations. Yes/No *If applicable, are you available to work overtime? Yes/No *If you are offered employment, when would you be available to begin work? *What reasonable accommodation, if any, would you request? *Have you ever been convicted of a felony or misdemeanor? Yes/No *THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT. If you were ever convicted please enter the Date, City, and State below.Conviction:Applicant's Skills List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability. Reason Time employment, Skill & Years of Experience *Rate Your Ability 1 through 5 *12345Skill & Years of Experience *Rate Your Ability 1 through 5 *12345Skill & Years of Experience *Rate Your Ability 1 through 5 *12345Applicant Employment History List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application. Employer Name *Supervisor Name *Company Phone Number *Job Duties *Address *Dates of Employment (Month/Year) *Reason for Leaving *Employer Name *Supervisor Name *Company Phone Number *Job Duties *Address *Dates of Employment (Month/Year) *Reason for Leaving *Employer Name *Supervisor Name *Company Phone Number *Job Duties *Address *Dates of Employment (Month/Year) *Reason for Leaving *Applicant's Education and Training College/University Name and AddressDid you receive a degree? Yes/NoHigh School/GED Name and Address *Did you receive a Diploma? Yes/NoOther Training (graduate, technical, vocational):Please indicate any current professional licenses or certifications that you hold: Awards, Honors, Special Achievements:List any two non-relatives who would be willing to provide a reference for you. Name *FirstLastPhone Number *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeName *FirstLastPhone Number *AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePlease provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:Upload your resume * Drag & Drop Files, Choose Files to Upload CERTIFICATION I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Elite Technician Management Group to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Manager, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Elite Technician Management Group, except in a specific written contract of employment signed on behalf of the organization by its Manager, has the power to alter or vary the voluntary nature of the employment relationship. Checkboxes *I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.Date / Time *Name *FirstLastSignature * Clear Signature Pre-Employment Notice: Background Check and Drug Screening As part of our commitment to safety, compliance, and to meet client requirements, Elite Technician Management Group and its affiliate companies (“Company”), require that all offers of employment be contingent upon successful completion of the pre-employment screening requirements outlined below. PRE-EMPLOYMENT BACKGROUND CHECK All final candidates are required to successfully complete a comprehensive background check prior to beginning employment. Background checks will also be conducted annually during employment, and at other times as deemed necessary based on job duties, safety considerations, or client requirements. Additional background checks may be required depending on the position. In evaluating background check results, the Company applies standards that are job-related, safety-focused, and consistent with applicable law. Factors that may result in disqualification include, but are not limited to, the following: Active warrants or current confinement at the time of review; Recent DUI, DWI, license suspension, or revocation where driving is a required job function; Felony convictions involving violence, dishonesty, theft, or similar conduct that are reasonably related to the position; A pattern of job misrepresentation or falsified credentials, including false statements regarding employment history, education, or licenses; Inclusion on a sex offender registry, where relevant to job duties, site access, or client requirements. Background check results are evaluated on an individualized basis, taking into account the nature of the position, the relevance of the findings, the time elapsed, and applicable client or contractual requirements. If a candidate does not meet the above background check standards, the offer of employment will be formally withdrawn. Candidates may request a copy of their background check results. Background checks may include, but are not limited to: Social Security Number Verification Prior Employment Verification Sex Offender Registry Search Global Watch List State and County Criminal History Federal Criminal History Federal Databases Public Records Searches Media Searches U.S. Department of the Treasury – Office of Foreign Assets Control (OFAC) Motor Vehicle Records (MVR/DMV), including ongoing monitoring where applicable Commercial Driver’s License (CDL) medical information, if applicable to the position PRE-EMPLOYMENT DRUG SCREENING Upon receipt of an offer of employment, candidates must complete all required pre-employment drug testing within twenty-four (24) hours. All testing will be conducted by a Company approved, licensed independent medical laboratory, in accordance with applicable state law. Drug testing will be performed using a urine sample and conducted under procedures designed to ensure employee privacy while protecting the integrity of the testing process. In addition to pre-employment drug screening, annual drug testing and testing as otherwise deemed necessary may be required during employment. Company will pay the cost of all required drug testing. If a candidate receives a positive result on an initial screening, the offer of employment will be formally withdrawn. Candidates may request a copy of their test results. ACKNOWLEDGMENT I acknowledge that I have received this Pre-Employment Notice and understand that my offer of employment is contingent upon successful completion of the background check and drug screening requirements described above. Name *FirstLastDate / Time *Signature * Clear Signature Submit