Landfill Application

Landfill Application for Employment

Step 1 of 6

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
How long at this address?
Date of birth*
MM slash DD slash YYYY
Primary phone number*
Email address
Referred by

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Most recent (or current) employer
Name of Employer
Date Started
MM slash DD slash YYYY
Are you currently employed here?
- Yes
- No
May we contact this employer?
- Yes
- No
End Date
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Salary (upon leaving)
Position
Reason for leaving
Would you like to add a second previous employer?
- Yes
- No
Second Previous Employer
Name of Employer
Date Started
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Salary (upon leaving)
Position
Reason for leaving
Would you like to add a third previous employer?
- Yes
- No
Third Previous Employer
Name of Employer
Date Started
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Salary (upon leaving)
Position
Reason for leaving
If you have additional employment you would like to tell us about, please upload a copy of your resume or a document that summarizes that employment.
Max. file size: 300 MB.

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References
Please list below at least three persons not related to you, whom you have known at least one year.
Name Address Position Years Acquainted
If you are to be hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.
Applicant Certification
AUTHORIZATION*
I certify that the facts contained in this application (and accompanying resume, if any) are true and complete to the best of my knowledge. I understand that any false
statement, omission, or misrepresentation on this application is sufficient cause for refusal to hire, or dismissal if I have been employed, no matter when discovered
by the Company.

I understand that any employment is conditioned on a background check. I authorize the Company to thoroughly investigate all statements contained in my
application or resume, and I authorize my former employers and references to disclose information regarding my former employment, character and general
reputation to the Company, without giving me prior notice of such disclosure. In addition, I release the Company, any former employers and all references listed
above from any and all claims, demands or liabilities arising out of or related to such investigation or disclosure.

I understand and agree that nothing contained in this application, or conveyed during any interview, is intended to create an employment contract. I further
understand and agree that if I am hired, my employment will be “at will” and without fixed term, and may be terminated at any time, with or without cause
and without prior notice, at the option of either myself or the Company. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the Company unless made in writing.

If I am offered employment I agree to submit to a medical examination and drug test before starting work. If employed, I also agree to submit to a medical
examination or drug test at any time deemed appropriate by the Company and as permitted by law. I consent to such examinations and tests, and I request that the
examining doctor disclose to the Company the results of the examination, which results shall remain confidential and segregated form my personnel file. I
understand that my employment or continued employment, to the extent permitted by law, is contingent upon satisfactory medical examinations and drug test, and if I
am hired a condition of my employment will be that I abide by the Company’s Drug and Alcohol Policy.

I understand that filling out this form does not indicate there is a position open and does not obligate the Company to hire. If hired, I agree to abide by all Company work rules, policies and procedures. The Company retains the right to revise its policies or procedures, in whole or in part, at any time.

I UNDERSTAND AND ACCEPT THE TERMS

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Providing waste hauling and disposal services throughout Central Kentucky.
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Landfill Application for Employment

Step 1 of 6

Personal Information

Employment Desired

Education

Work Qualifications

Most recent (or current) employer

Second Previous Employer

Third Previous Employer

References

Applicant Certification

Name	Address	Position	Years Acquainted

Apply Online

Landfill Application for Employment

Step 1 of 6

Personal Information

Employment Desired

Education

Work Qualifications

Most recent (or current) employer

Second Previous Employer

Third Previous Employer

References

Applicant Certification