Matrix Energy Services, Inc.Application for Employment

Thank you for your interest in a career with Matrix Energy Services. Please complete the following application as accurately as possible.

Your full legal name:

Your phone number:

Your email address:

Your address:

Space Cell	Address	City	State	Zip
	Address	City	State	Zip

Estimated date on which you would be available for employment (mm/dd/yyyy): This question requires a valid date format of MM/DD/YYYY.

calendar

Title of position for which you are applying:

1. Position location (select all that apply):

Sacramento, CA
Other location (please specify) Please enter an 'other' value for this selection.

Your desired starting salary:

If extended an offer of employment, can you provide verification of your right to work in the United States?

Have you previously been employed by Matrix Energy Services?

When did you previously work for Matrix Energy Services?

Have you ever been convicted of any crime that resulted in imprisonment, probation, or the payment of a fine/forfeiture or bail of $50 or more?

(NOTE: A yes answer does not automatically disqualify you from employment.)

Please explain:

(NOTE: You do not need to answer yes or explain: 1) any conviction for which the record has been judicially ordered sealed, expunged, or statutorily eradicated; 2) any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed pursuant to Penal Code section 1203.4; or 3) misdemeanor convictions for marijuana-related offenses that are more than two years old.)

Please list your relevant education.

Space Cell	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)
High School	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)
College	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)
College	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)
College	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)
Trade / Special School	Institution Name	Degree Type	Major	Start Date (mm/yyyy)	End Date (mm/yyyy)

Please describe any certifications or training you have received pertaining to the position for which you are applying.

Please provide information about your current employer (or most recent employer, if you are not currently employed).

Space Cell
Company Name
City / State
Phone Number
Start Date (mm/yyyy)
End Date (mm/yyyy)
Supervisor Name
Salary

May we contact this company for a reference?

Please briefly explain your job responsibilities and reason for leaving this company or seeking a new employment opportunity.

Please provide information about your second most recent employer.

Space Cell
Company Name
City / State
Phone Number
Start Date (mm/yyyy)
End Date (mm/yyyy)
Supervisor Name
Salary

May we contact this company for a reference?

Please briefly explain your responsibilities and reason for leaving this company.

Please provide information about your third most recent employer.

Space Cell
Company Name
City / State
Phone Number
Start Date (mm/yyyy)
End Date (mm/yyyy)
Supervisor Name
Salary

May we contact this company for a reference?

Please briefly explain your responsibilities and reason for leaving this company.

Have you served in the military?

Please provide the following information regarding your military service.

Space Cell	Branch	Start Date (mm/yyyy)	End Date (mm/yyyy)	Rank at Discharge
	Branch	Start Date (mm/yyyy)	End Date (mm/yyyy)	Rank at Discharge

Please describe your military duties and job category.

Were you honorably discharged from military service?

If you were other than honorably discharged, please explain.

2. How did you hear about the job you are applying for?

Please enter an 'other' value for this selection.

What was the online source you used to find this job?

Please list three professional references.

Space Cell	Name	Relationship	Phone Number
1.	Name	Relationship	Phone Number
2.	Name	Relationship	Phone Number
3.	Name	Relationship	Phone Number

Electronic Signature

By checking this box, I certify that my answers made herein or otherwise by me in applying for a position at Matrix Energy Services, Inc. are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that employment is contingent upon my provision of written verification of my identity and legal right to work in the United States.