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Please complete the form below. If you require assistance please call us at: 1-800-592-0848

First Name:
             MI:
Last Name:
Email Address:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
 
Emergency Contact
Name:
Relationship:
Phone #:
Cell Home Work
 
1. Are you 18 years or older?
Yes No
2. If hired, can you submit verification of your legal right to work in the U.S.?
Yes No
3. Have you ever been convicted of a Misdemeanor or a Felony?*
Yes No
* If yes, write explanation in box below (this will not necessarily disqualify your application)
 
 
(please check all that apply):
CPR Certified
expiration date:
First Aid Certified
expiration date:
Bilingual:
please list language(s):
 
Please list the hours you would usually be available to work with us:
Not Available        
Monday
From
Until
Tuesday
From
Until
Wednesday
From
Until
Thursday
From
Until
Friday
From
Until
Saturday
From
Until
Sunday
From
Until
 
Additional Availability Information:
 
 
Highest level of education completed:
Masters   
Associates
 
Bachelors  
High School/GED 
Please list your major(s):
 
 
Company:
Company Phone:
Supervisor:
Supervisor Phone:
Dates:
 
To:
Address:
City:
State:
Zip Code:
Job title and duties:
Reason for leaving:
 
Company:
Company Phone:
Supervisor:
Supervisor Phone:
Dates:
To:
Address:
City:
State:
Zip Code:
Job title and duties:
Reason for leaving:
 
Company:
Company Phone:
Supervisor:
Supervisor Phone:
Dates:
 
To:
Address:
City:
State:
Zip Code:
Job title and duties:
Reason for leaving:
 
Please list the names and phone numbers of three people not related to you
 that can provide insight on your work history.
Name:
Dates:
Relationship:
To:
Phone:
Address:
City:
State:
Zip Code:
 
Name:
Dates:
Relationship:
To:
Phone:
Address:
City:
State:
Zip Code:
 
Name:
Dates:
Relationship:
To:
Phone:
Address:
City:
State:
Zip Code:
 
 
I certify that this information is accurate and complete.

Giving incomplete or false information is a serious matter and is grounds for dismissal and forfeiture of related benefits. I authorize NTT&EP and any of its authorized representatives, to investigate any and all of the information contained in this application and to conduct additional investigations of my experience and background as it relates to my application for hire.

I give my permission to my past employers to provide my performance history to NTT&EP. I understand that if hired, my status will be that of an employee at will, with no contractual right, express or implied, to remain in the employer's employ. In consideration of my employment, I specifically agree that my employment may be terminated, with or without cause or notice. I understand that no representations will be made, express or implied, which are contrary to the foregoing. This statement of policy is not subject to change. I have read and understand and agree to the provisions of this application.