Applicant InformationName First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Are there any other names under which you have worked or attended school? Yes No Other Name(s) Are you authorized to work in the U.S.?*If hired, you will be required to provide proof of work authorization. Yes No Are you at least 18 years old?*If not, your employment will be subject to verification that you meet state/federal minimum age requirements for the type of work you are applying for and have obtained a valid work permit. Yes No Have you ever been convicted of a crime or pled no contest for any offense or violation other than minor traffic violations? Yes No If yes, explain 1) nature of crime, 2) date of conviction, and 3) state in which convicted.*Convictions are not automatic bar to employmentPositionPosition Applied For Date Available MM slash DD slash YYYY AvailabilitySelect all that apply Monday Wednesday Friday Tuesday Thursday Weekends Availability Additional On Call Weekdays First Shift On Call Weekends Second Shift Hourly Rate / Salary Desired Education & SkillsSecondary EducationHigh school or equivalent, name & location (city, state) H.S. diploma or equivalent General Diploma General Education Development (GED) College, Vocational or Trade SchoolName and location of school (city, state) College, Vocational or Trade School CourseCourse of study College, Vocational or Trade School - yearsNo. of years completed College, Vocational or Trade School - degreeType of degree or diploma received Other Post-Secondary TrainingName and location of training (city, state) Other School - Course StudyDescription of training or course of study College, Vocational or Trade School - yearsNo. of years completed Other Schooling = degreeType of certification or degree received Computer SkillsPlease list/describe software knowledge and office equipment experience.Special TrainingPlease list any special skills, training or certifications that are relevant to the position you are applying for.EmploymentCurrent (or most recent) employer PhoneJob title Direct Supervisor Employment DatesStarting/ending dates (month and year) Reason for leaving(if applicable) Resume *requiredPlease submit full employment history by uploading your resume in PDF or Word format. (Max file size 99MB) Applications must include a resume to be considered. If you are unable to upload your resume to this application, please email it to [email protected]Accepted file types: doc, docx, pdf, txt, odf, Max. file size: 100 MB.ReferencesPlease list 2-3 individuals familiar with your job qualifications (no relatives or personal friends). Include full name, phone and email. Please read carefully before completing the application:*Clean Fuel Partners, LLC is an organization that believes in the principles of fairness, equity and equal opportunity, and does not discriminate on the basis of age, race, color, national origin or citizenship status, creed, religion, religious affiliation, sex (including pregnancy), marital status, status with regard to public assistance, political affiliation, arrest or conviction record, sexual orientation, gender identity, disability, veteran status or any other pprotected status recognizd by Wisconsin or federal law. I certify all information contained in this application is true and correct to the best of my knowledge and belief. I understand that misrepresentations or omissions of any kind may result in denial of employment or be cause for subsequent dismissal if I am hired. I give Clean Fuel Partners, LLC the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability Clean Fuel Partners, LLC and its representatives for seeking, gathering, and using such information and all other persons, corporations or organizations for furnishing such information. Regardless of whether or not I become employed by Clean Fuel Partners, LLC, I recognize that this application is not and should not be considered a contract of employment. I understand that employment at Clean Fuel Partners, LLC is on an at will basis and that my employment may be terminated at any time, at my option or Clean Fuel Partners, LLC’s. Clean Fuel Partners, LLC is committed to providing a safe and healthy workplace in compliance with Occupational Safety and Health Administration (OSHA) standards. My signature acknowledges that I have read, understood and agree to this statement. I understand that all records pertaining to my employment are to remain the property of the company. I further fully understand that, if requested, I agree to sign the Clean Fuel Partners, LLC Confidentiality Agreement or not to divulge confidential information. I agree to the termsCommentsThis field is for validation purposes and should be left unchanged.
