Wire Guard Application - All Utility Support Services

Full Name*

First Middle Last

Date

Address

Street Address Address Line 2 City State ZIP Code

Email*

Cell Phone*

Vehicle To Be Used (Year, Make, & Model)*

How Did You Hear About Us? (Referral)*

Are you a citizen of the United States?*

Yes
No

If no, are you authorized to work in the U.S.?*

Yes
No

Are you at least 18 years or older?*

Yes
No

Do you have a Smart Phone?*

Yes
No

Can you travel for multi-day assignments?*

Yes
No

Can you work a 12-16 hour day shift?*

Yes
No

Can you work a 12-16 night shift?*

Yes
No

Where are you located?*

Orange & Rockland Service Territory
Central Hudson Service Territory
Other

Skills for Administrators/Coordinators

Are you skilled at Word documents?*

Yes
No

Can you use Excel Spreadsheets?*

Yes
No

Can you use GPS on your smartphone?*

Yes
No

Can you use Email?*

Yes
No

Prior Work Experience:

List*

From	To	Company	Position

Driver’s License Information

State:*

Expiration Date:*

Consent To Release Records

DRIVER NAME*

(AS SHOWN ON LICENSE)

Driver's License #*

DOB:*

By signing below, I voluntarily give consent to the New York State Department of Motor Vehicle (NYSDMV) to release the following record(s), including personal information within my driver license file. I request the record(s) indicated by my signature below to be released by the NYSDMV, their agents and employees, to All Bright Support Services:

DRIVER'S SIGNATURE OF CONSENT:

Emergency Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Primary Phone**

Email*

Relationship to Applicant:*

Disclaimer and Signature

Disclaimer and Signature Please read carefully before signing.

All Bright Support Services, Inc. is an equal opportunity employer. All Bright Support Services, Inc. does not discriminate in employment on account of race, color, religion, national origin, citizenship status, ancestry, age, sex (including sexual harassment), sexual orientation, marital status, physical or mental disability, military status or unfavorable discharge from military service.

I understand that neither the completion of this application nor any other part of my consideration for deployment establishes any obligation for All Bright Support Services, Inc. to contract with me. If I am deployed, I understand that either All Bright Support Services, Inc. or I can terminate my deployment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of All Bright Emergency Support Services, Inc. has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to All Bright Support Services, Inc. true and complete information on this application. No requested information has been concealed. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. A valid license and driving record will be checked.

Signature

Date