To the Applicant: We appreciate your interest in Sustainable Engineering Group (SEG). The information requested in this form will give us a clear understanding of your qualifications, background, and work history, and will aid us in placing you in a position for which you are best suited. If you are hired, employment will be “at-will”, meaning that you will not have a contract for a specific duration and can be terminated at any time for reason, with or without cause. The Civil Rights Act of 1964, as amended, prohibits discrimination in employment because of race, color, sex, religion or national origin. The Age Discrimination in Employment Act of 1967, as amended, prohibits discrimination because of age. The Americans with Disabilities Act prohibits discrimination against those with disabilities. Various state laws prohibit some of the above as well as other types of discrimination. As an Equal Employment Employer, SEG intends to comply fully with all applicable federal and state employment laws. Position InformationPosition Desired*Date:* Have you ever applied for a position with us?*YesNoIf yes, when? Which position?How did you learn about our organization?*SearchEmployeeOther CompanyAgencySelfEmployment ServiceSalary expectations per year $Do you have legal permission to work in the United States?YesNoDate Available to Start:* Applicant InformationFull Name (First + Middle Initial + Last)* First Middle Last Address* Street Address Apartment/Unit # City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* EducationWhere did you attend high school & college? (Click the + button to add a new row)*School Name & AddressMajorYears CompletedGPADegree/Diploma Add the most recent first.Previous EmploymentCompany Name (Most Recent or Current)PhoneAddress Street Address City State / Province / Region ZIP / Postal Code Supervisors Name & TitleJob TitleResponsibilities Start Date End Date Reason for Leaving?Type of BusinessSalaryStarting Salary $Ending Salary $ May we contact your previous supervisor for a reference?YesNoCompany Name (Second Most Recent)PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country SupervisorsJob TitleSalaryStating Salary $Ending Salary $ Responsibilities Start Date End Date Reason for Leaving?May we contact your previous supervisor for a reference?YesNoWould you like to list another previous job?YesNoCompany Name (Third Most Recent)PhoneAddress Street Address City State / Province / Region ZIP / Postal Code SupervisorJob TitleSalaryStarting Salary $Ending Salary $ Reponsibilities Start Date End Date Reason for Leaving?May we contact this employer?YesNoWould you like to list a 4th job?YesNoCompany Name (Fourth Most Recent)PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code SupervisorJob TitleSalaryStarting Salary $Ending Salary $ Responsibilities Start Date End Date Reason for Leaving?May we contact this employer?YesNoReferencesList 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)NameRelationshipCompanyPhoneAddress DisclaimerI certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false, omitted or misleading information in my application or interview may result in my dismissal. Digital Signature:Printing your First Name + Middle Initial + Last Name will act as your digital signature.Resume Upload (optional)If you have a resume you'd like to attach, please do so here. This is not required.Would you like to add a cover letter?YesNoCover Letter (optional)Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below. CommentsThis field is for validation purposes and should be left unchanged.