AB HOXIE, INC. IS A
PROUD MEMBER OF THE
NATIONAL GROUND
WATER ASSOCIATION,
RI GROUND
WATER ASSOCIATION &
THE RI BUILDERS ASSOCIATION

Employment Opportunities

We are currently hiring for the following positions:

General Laborer
Service Technician for Well Pump Systems
Filtration Service Technician
Office Staff

If you are interested in applying for any of these positions, please fill out & submit the form below.

Personal Information

Your Name *

Date of Birth *

Drivers License Number *

Social Security No. *

Present Address *

Country

City

State

Zip code

Mailing Address *

Country

City

State

Zip code

Phone Number *

Secondary Phone Number

Referred By

Employment Desired

Position applying for *

Date You Can Start *

Salary Desired *

Ever applied to this company before?

Education History

Name & Location of High School

Years Attended

Did you graduate?

Subjects Studied in High School

Name & Location of College

Years Attended

Did you graduate?

Subjects Studied in College

Trade, Business or Correspondence School

Years Attended

Did you graduate?

Subjects Studied in this/these school(s)

General Information

Special/Trade Skills

Trade Licensing

Former Employers

List below last four employer, starting with last one first

Name & Address of Employer

From

Salary

Position

Reason for Leaving

Name & Address of Employer

From

Salary

Position

Reason for Leaving

Name & Address of Employer

From

Salary

Position

Reason for Leaving

Name & Address of Employer

From

Salary

Position

Reason for Leaving

References

Name

Business

Years Known

Address

Country

City

State

Zip code

Name

Business

Years Known

Address

Country

City

State

Zip code

Name

Business

Years Known

Address

Country

City

State

Zip code

Authorization

“I certify that the facts contained in this application are true and complete to the best of my knowledge
and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed
above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any
agreement for employment for any specified period of time, or to make any agreement contrary to the
foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner
prohibited by the Americans with Disabilities Act (ADA) and other relavent federal and state laws.”

Date *

Signature *

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