Application Form

SECC Employee Application

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PLEASE COMPLETE PAGES 1-5

Date

MM slash DD slash YYYY

Name(Required)

First Middle Last

Present address

Street Address Address Line 2 City ZIP Code

How long at current address?

Date of Birth

Month

Day

Year

Social Security No

Telephone(Required)

Are you under age 18

Yes

if “YES”, can you provide proof of your eligibility to work?

Yes

Proof of eligibility will be required if hired.

Yes

Proof of eligibility will be required if hired.(Be specific)

Position applied for (1)

and wage desired (2)

Days/hours available to work

No Pref

Mon

Tue

Wed

Thurs

Fri

Sat

Sun

How many hours can you work weekly?

Employment desired

FULL-TIME ONLY

PART-TIME ONLY

FULL- OR PART-TIME

When are you available to start work?

Have you ever applied or worked for SECC Holdings LLC before?

Yes

If yes, when?

How did you hear about SECC Holding LLC?

Have you ever been convicted of a crime?

Yes

If yes, explain:

Please add your education ( e.g High School, College, Bus. or Trade School, Professional School)

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION (Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

you can add more by clicking plus sign

Have you ever been convicted of a crime which is substantially related to the functions or qualifications of the job for which you are applying

Yes

(a Conviction record will not necessarily disqualify you from employment).

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation.

DO YOU HAVE A DRIVER’S LICENSE?

Yes

What is your means of transportation to work?

Driver’s license

number

State of issue

Expiration date

select one

Operator

Commercial (CDL)

Chauffeur

Have you had any accidents during the past three years?

How many?

Have you had any moving violations during the past three years?

How many?

OFFICE POSITIONS ONLY

Typing

Yes

Words Per minute

10-key

Yes

Words Processing

Yes

Words Per minute

Personal Computer

Yes

Personal Computer

Mac

Other Skills

Please list two references other than relatives.

Person One

Name

Position

Company

Address

Telephone

Person Two

Name

Position

Company

Address

Telephone

Please use this space to elaborate on any background, DDD trainings, experience, or qualifications that you believe should be considered in evaluating your qualifications for employment. You may include hobbies, volunteer experience and any other activities

you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?

Yes

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

Yes

Specialty

Date Entered

Discharge Date

Work Experience

Please list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

Address

City State / Province / Region ZIP / Postal Code

Phone number

Name of last supervisor

Employment dates(From)

Employment dates(To)

Pay or salary(Start)

Pay or salaryFinal

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer?

Yes

SECC Employee Application

Step 1 of 3

33%

Hidden

Next Steps: Sync an Email Add-On

PLEASE COMPLETE PAGES 1-5

Date

MM slash DD slash YYYY

Name(Required)

First Middle Last

Present address

Street Address Address Line 2 City ZIP Code

How long at current address?

Date of Birth

Month

Day

Year

Social Security No

Telephone(Required)

Are you under age 18

Yes

if “YES”, can you provide proof of your eligibility to work?

Yes

Proof of eligibility will be required if hired.

Yes

Proof of eligibility will be required if hired.(Be specific)

Position applied for (1)

and wage desired (2)

Days/hours available to work

No Pref

Mon

Tue

Wed

Thurs

Fri

Sat

Sun

How many hours can you work weekly?

Employment desired

FULL-TIME ONLY

PART-TIME ONLY

FULL- OR PART-TIME

When are you available to start work?

Have you ever applied or worked for SECC Holdings LLC before?

Yes

If yes, when?

How did you hear about SECC Holding LLC?

Have you ever been convicted of a crime?

Yes

If yes, explain:

Please add your education ( e.g High School, College, Bus. or Trade School, Professional School)

TYPE OF SCHOOL

NAME OF SCHOOL

LOCATION (Complete mailing address)

NUMBER OF YEARS COMPLETED

MAJOR & DEGREE

you can add more by clicking plus sign

Have you ever been convicted of a crime which is substantially related to the functions or qualifications of the job for which you are applying

Yes

(a Conviction record will not necessarily disqualify you from employment).

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed and type(s) of rehabilitation.

DO YOU HAVE A DRIVER’S LICENSE?

Yes

What is your means of transportation to work?

Driver’s license

number

State of issue

Expiration date

select one

Operator

Commercial (CDL)

Chauffeur

Have you had any accidents during the past three years?

How many?

Have you had any moving violations during the past three years?

How many?

OFFICE POSITIONS ONLY

Typing

Yes

Words Per minute

10-key

Yes

Words Processing

Yes

Words Per minute

Personal Computer

Yes

Personal Computer

Mac

Other Skills

Please list two references other than relatives.

Person One

Name

Position

Company

Address

Telephone

Person Two

Name

Position

Company

Address

Telephone

you believe relevant. Please omit any information that would disclose your race, gender, age, marital status, ethnic origin, religious or political affiliations, or disability.

MILITARY

HAVE YOU EVER BEEN IN THE ARMED FORCES?

Yes

ARE YOU NOW A MEMBER OF THE NATIONAL GUARD?

Yes

Specialty

Date Entered

Discharge Date

Work Experience

Please list your work experience for the past seven years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.

Name of employer

Address

City State / Province / Region ZIP / Postal Code

Phone number

Name of last supervisor

Employment dates(From)

Employment dates(To)

Pay or salary(Start)

Pay or salaryFinal

Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer?

Yes