Application for Employment - Northeast Safety, Inc.

Northeast Safety, Inc is an Equal Opportunity and EEO/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Complete the entire application. You may attach a resume, but you must still complete all questions; or your application will be deemed incomplete and may not be considered. Please fill out each box (don’t just indicate “Same” or “See Resume”). If you are unable to use this form, please Click here to download our PDF employment application.

Personal Information

First Name:

Last Name:

Mid Init:

Legal Address:

City:

State (abbrev):

Zip:

Residence (required)

Mailing Address:

City:

State (abbrev):

Zip:

PO Box or RR (in addition to residence noted above, if applicable)

Telephone (home):

Mobile phone:

Email:

Do you have a Driver's License and a Reliable Vehicle?

Yes No

Are you at least 18 years of age?

Yes No

Are you legally eligible for employment in the United States?

Yes No

Please list your weekly availability:

Work Experience
Please detail your work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Attach additional sheets if necessary. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.”

PLEASE NOTE: Northeast Safety, Inc. reserves the right to contact all current and former employers for reference information.
List your previous employer(s), starting with the current or most recent.

Employer A:

Address:

City, State

Zip:

Phone:

Start Date (month/year):

End Date (month/year):

Starting Pay:

Ending Pay:

Job Title:

Supervisor:

Reason for Leaving:

Responsibilities:

Employer B:

Address:

City, State:

Zip:

Phone:

Start Date (month/year):

End Date (month/year):

Starting Pay:

Ending Pay:

Job Title:

Supervisor:

Reason for Leaving:

Responsiblitites:

Education

High School:

City, State:

Highest Grade Completed:

Major:

College:

City, State:

Number of Years Completed:

Major, Degree:

Please list any other courses or certifications relevant to a position with Northeast Safety, Inc.

Optional: Attach your resume or other supporting file

Acceptable file types: doc,docx,pdf,txt.
Maximum file size: 10mb.

CERTIFICATION and AGREEMENT

By using this form I voluntarily give Northeast Safety, Inc. the right to make a thorough investigation of my past employment activities and personal history that is job related, agree to cooperate in such investigation, and release from all liability or responsibility all persons, companies and corporations supplying such information. I consent to taking any post-offer physical examination, medical or drug tests that might be required by Northeast Safety, Inc in order to determine my ability to perform job duties. I authorize the release of the results of such exams or tests to Northeast Safety, Inc.

I understand that if I accept employment at Northeast Safety, Inc, I may terminate employment at any time and may be terminated at any time, with or without cause, and that I have no express or implied contract for continued employment.

I certify that the above information and information on my resume is true and accurate to the best of my knowledge and understand that if I misrepresent or leave out a fact on my application or resume, I may be refused employment or if employed, I may be terminated immediately.