Employment Application

Employment Application

We are an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.
Resume
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Your E-mail Address*
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How Did You Hear About Us?
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Position Applying For*
  • Please select one:
  • CEO/President
  • QC/Quality Tech
  • Field Sampling Tech I
  • Field Sampling Tech II
  • Field Sampling Tech III
  • Lab Tech I
  • Lab Tech II
  • Lab Tech III
  • Lab Tech III
  • Associate Project Manager
  • Log In Technician
  • Environmental Scientist
  • Support Tech - Cooler
  • Regional Manager
  • Accounts Receivable Clerk
  • Business Development Executive
  • Maintenance Manager
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Applicant Information

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  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Have you ever filed an application with us before?
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When can you work?*
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Day you can start work?*
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May we contact your present employer?
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Are you currently on "lay-off" status and subject to recall?
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Are you currently enrolled in school?
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Do you use tobacco in any form?
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Are you authorized to work in the U.S.?*
Proof of citizenship or immigration status will be required upon employment.
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If the position you are applying for requires you to drive a company vehicle, how many traffic violations or accidents have you had within the last three years?
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Are you physically or otherwise unable to perform the duties of the job for which you are applying?
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Are you able to lift 60 pounds to waist-height safely?
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Can you relocate out of town?
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Have you been convicted of a felony in the past 7 years?*
Conviction will not necessarily disqualify an applicant from employment.
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Education

Highschool Attended:
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Years Completed:
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Did you graduate?
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College Attended:
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Years Completed:
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Did you graduate?
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Degree:
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Graduate/Professional
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Years Completed:
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Did you graduate?
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Degree:
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College Hours (Chemistry)
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College Hours (Biology)
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College Hours (Microbiology)
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Special Skills & Attributes

Describe any specialized training, apprenticeship, skills and extra-curricular activities:
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Describe any honors you have received:
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State any additional information you feel may be helpful to us in considering your application:
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Experience

Start with your last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap, or other protected status.
Company Name
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Address
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City
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Phone
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Supervisor
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Zip
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Job Title
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Responsibilities
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Start Date
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End Date
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Starting Salary
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Ending Salary
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Reason for Leaving
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May we contact for a reference?
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Company Name
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Address
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City
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Phone
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Supervisor
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Zip
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Job Title
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Responsibilities
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Start Date
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End Date
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Starting Salary
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Ending Salary
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Reason for Leaving
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May we contact for a reference?
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Company Name
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Address
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City
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Phone
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Supervisor
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Zip
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Job Title
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Responsibilities
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Start Date
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End Date
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Starting Salary
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Ending Salary
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Reason for Leaving
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May we contact for a reference?
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Company Name
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Address
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City
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Phone
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State
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Supervisor
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Zip
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Job Title
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Responsibilities
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Start Date
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End Date
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Starting Salary
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Ending Salary
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Reason for Leaving
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May we contact for a reference?
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References

Give name, address, and telephone number of four references who are not related to you and are not previous employers.
Name*
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Address*
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Phone*
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Name*
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Address*
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Phone*
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Name*
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Address*
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Phone*
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Name*
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Address*
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Phone*
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Authorization and Consent for Release of Information

Please Read Carefully
This application for employment shall be considered active for ninety (90) days. Any applicant wishing to be considered for employment beyond this time period should re-apply.

I, the undersigned, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that, if I am employed, any false statements will be considered as cause for possible dismissal.

I authorize Ana-Lab Corp. and any of its agents/designated Company Personnel, to disclose orally and in writing the results of this verification process and/or interview to the designated authorized representative of this Company.

I have read and understood this release and consent, and I authorize the background verification. I authorize persons, schools, current and former employers, and other organizations and Agencies to provide Ana-Lab Corp. with all information that may be requested and to conduct a verification of my motor vehicle records.

I do hereby agree to forever release and discharge Ana-Lab Corp. and their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs, and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting of information.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization if of an “at-will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at-will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I understand that I am required to abide by all the rules and regulations of the employer.

Your signature below verifies you have read the above notice and understand what it means.
Signature*
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Date*
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Date of Birth*
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State*
  • - select a state -
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
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Driver's License Number*
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Confidential Survey

To All Applicants:
Qualified applicants are considered for employment, and employees are treated during employment, without regard to race, color, religion, sex, national origin, age, marital status, veterans’ status, or disability. However, government agencies require periodic reports on the sex, ethnicity, disability, and veteran status of applicants. This data is for statistical analysis with respect to the success of the Affirmative Action program.

This survey is kept in a confidential file and not part of your application for employment or personnel file, should you be hired. No information contained in this survey is used in any way to discriminate in any employment practice.

Submission of this information is voluntary.
Full Name
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Date
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Position Applied For
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Birth Date
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Sex
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Race
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Veteran Status

The information supplied will be used only in support of veterans programs in accordance with the regulations implementing 38 U.S.C. 4212. Check all that apply.
Vietnam Era Veteran
A person who served more than 180 days of active military, naval, or air service, any part of which was during the period of August 5, 1964, through May 7, 1975; and
i. Was discharged or released therefrom with other than dishonorable discharge, or
ii. Was discharged or released from active duty because of a service-connected disability.

Special Disabled Veteran
i. A veteran who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Department of Veteran Affairs for a disability.a. Rated at 30 percent or more orb. Rated at 10 or 20 percent in the case of a veteran who has been determined under section 1506 of Title 38, U.S.C. to have a serious employment disability, or
ii. A person who was discharged or released from active duty because of service-connected disability.
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A person with a disability is one who (1) has a physical or mental impairment which substantially limits one or more of a person’s major life activities, (2) has a record of such impairment, or (3) is regarded as having such impairment. An individual with a disability is “substantially limited” if he/she is likely to experience difficulty in securing, retaining, or advancing in employment because of a disability. This information is used only in accordance with the Rehabilitation Act of 1973, as amended, and Title 41 CFR 60-741.
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Please state nature of disability
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This information is given on a voluntary basis.

Signature*
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Date*
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Ana-Lab