New Iberia Office is Now Open!

Company Picnic – 2026 Summer

June 16, 2026

A Look Back at Our Summer Picnic

This year’s Summer Picnic took place on May 29 at Mid-South’s Corporate office in Shreveport.  It was all about sunshine, good food, and Western‑themed fun. Employees, spouses, and kids spent the afternoon hanging out, relaxing, and enjoying the outdoors together.

The giant water slide kept the kids busy nonstop, and the mechanical bull drew plenty of brave riders and lots of laughs. Families also had plenty of games and kid‑friendly attractions to enjoy throughout the day.

More than anything, the picnic gave everyone a chance to connect outside the office and celebrate the community that makes our company special. With great weather, family fun, and a little Western flair, it turned out to be one of our most memorable picnics yet.

Share:

Comments

Leave the first comment

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey

Mid South Fire Solutions Application for Employment

Mid South Fire Solutions is committed to fostering a diverse and inclusive workplace. All applicants are considered for employment based solely on their qualifications, without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, marital status, pregnancy, ancestry, disability (physical or mental), medical condition, military or veteran status, citizenship or immigration status, ethnicity, genetic information, or any other characteristic protected by applicable federal, state, or local laws. We proudly uphold equal opportunity principles in all aspects of our hiring and employment practices.

All information and results provided during the application process will be treated with the utmost confidentiality and used exclusively to support employment-related decisions. We respect your privacy and are committed to maintaining the integrity of your personal data throughout the hiring process.

Job descriptions are available and can be provided to applicant upon request.

Name:

GENERAL INFORMATION

Note: If under 18, hire is subject to verification that you are of minimum legal age.

15. Give name and telephone number of three references who are not related to you and are not previous employers.

EDUCATION

School Name

Specialized training, skills, or extracurricular activities

Did you graduate?

HIGH SCHOOL

COLLEGE

GRADUATE/PROFESSIONAL SCHOOL

TRADE SCHOOL

OTHER, please specify
Example: GED

Employment Experience

Start with your present or last job. Include military service assignments if they apply.

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Dates of Employment

Employer Name/City, State/Phone Number

Position

Reason for Leaving

Applicant's Statement and Agreement

Please read and initial each paragraph below. At any time, please ask the employment interviewer any questions regarding the conditions for explanations and/or clarifications.

• DMV records including Driver’s License information, Driving History (Records of traffic violations, accidents, DUI convictions, and points on the license), Vehicle Registration, Title History, Commercial Driving Records (CDL)
• Criminal convictions (Note: All applicants are given equal consideration, and past convictions are reviewed in context with the position requirements.")
• Prior employment history, except contacting my current employer unless my permission is granted above
• Educational background

I affirm that I have read this document in its entirety and consent to all stated conditions.

Clear Signature

Voluntary Affirmative Action Survey (Optional)

Voluntary Affirmative Action Survey