PERSONAL INFORMATION

    EMPLOYMENT DESIRED

    Position

    Date You Can Start*

    Hours Desired

    Education

    Name and Location of School

    Last Year Completed

    Did you Graduate?

    Subjects Studied and Degrees Received

    Grammer School

    High School *

    College

    Trade,Business or Corrospondence School

    GENERAL

    EXCLUDE ORGANIZATIONS, THE NAME OR CHARACTER OF WHICH INDICATES THE RACE, SEX, COLOR OR NATIONAL ORIGIN OF ITS MEMBERS

    former-employerList below your last four employers, starting with the last one first

    Date month And Year

    Name and Address of Employer

    Supervisor

    Position

    Reason of Leaving

    Date month And Year

    From * To *

    Name and Address of Employer

    Supervisor

    Position

    Reason of Leaving

    Date month And Year

    FromTo

    Name and Address of Employer

    Supervisor

    Position

    Reason of Leaving

    Date month And Year

    FromTo

    Name and Address of Employer

    Supervisor

    Position

    Reason of Leaving

    Date month And Year

    FromTo

    Name and Address of Employer

    Supervisor

    Position

    Reason of Leaving

    REFERENCESList below three persons not related to you, whom you have known for at least one year.

    Name

    Address

    Position

    Year Acquainted

    Name1*

    Address

    Position

    Year Acquainted

    Name2*

    Address

    Position

    Year Acquainted

    Name3

    Address

    Position

    Year Acquainted

    If you are to be hired by Toms Sierra Company, Inc. dba Sierra Energy, 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.

    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 Sierra Energy.
    I understand that if a condition of employment is to run a credit or background check, I hereby authorize Sierra Energy to do so. If a credit or background check is ran, I understand that I will have the opportunity to obtain a copy of such report upon my request. I authorize Sierra Energy 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 Sierra Energy, without giving me prior notice of such disclosure. In addition, I release Sierra Energy , 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 Sierra Energy. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Sierra Energy 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 as permitted by law. I consent to such examinations and tests, and I request that the examining doctor disclose to Sierra Energy the results of the examination, which results shall remain confidential and segregated from 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 Sierra Energy's Drug and Alcohol Policy.

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