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Name: |
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Current Address: |
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City/State/Zip: |
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Email Address: |
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How long have you
lived at this address? |
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Previous Address: |
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City/State/Zip: |
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How long did you
live at that address? |
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Are you over the
age of 18? |
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| If no, employment is
subject to verification that you are of minimum legal age. |
| Are you legally eligible to work in
the U.S. and can you provide proof that you can legally
be employed in the U.S.? |
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Position applying
for: |
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Type of employment? |
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Will you work overtime
if asked? |
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When will you be
available for work? |
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What hours can you
work? |
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Pay Expected: |
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Have you ever applied
for employment with us? |
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If yes, indicate
month, year and location: |
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Do you have any
relatives currently working for us? |
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If yes, give name
and location where employed: |
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How did you hear/learn
about us? |
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Have you ever been
bonded? |
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Have you ever been
refused bond? |
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If so, state reason and
date below:
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Have you ever been sentenced or convicted of ANY crime? |
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If so, state offense, date,
court and place where offense occurred:
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Have you ever been
discharged or requested to resign from a position? |
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If so, explain below:
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Does your present
employer know of your plans to change employment? |
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Why do you desire to make
a change?
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Have you ever held
a position of trust (handling
money or confidential material)? |
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Would you have steady
transportation to work? |
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| Please give accurate,
complete employment record. Start with your most recent
or present employer. Account for all periods of non-work
time. |
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Were you in the U.S. Armed
Forces?
If so, what branch?
Dates of duty, From:
To:
Rank at discharge:
List duties in the Service, including special training:
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Are there any other experiences, skills or qualifications
which you feel would especially fit you for work with this
organization?
If so, please list below:
Are you certified in Pest Control?
If yes, please give state of certification:
Date Certified:
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(DO NOT LIST RELATIVES OR FORMER EMPLOYERS)
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"The facts set forth in the
preceding pages of this, my Application for Employment,
are true and complete. I understand that if employed, false
statements on this application, or any misstatement or omission
of fact on this application, as well as the accuracy of
other data presented throughout the hiring process and employment,
will discontinue the hiring process, or if already employed
shall be considered sufficient cause for dismissal. You
are hereby authorized to make an investigation of my personal
history, financial and credit record, criminal background,
and driving record through any investigative or credit agencies
or bureaus of your choice.
"In making this Application for Employment, I also understand
that an investigative consumer report may be made whereby
information is obtained through personal interviews with
my neighbors, friends or others with whom I am acquainted.
This inquiry includes information as to my character, general
reputation, personal characteristics and mode of living.
I understand that I have the right to make a written request
within a reasonable period of time to receive addition,
detailed information about the nature and scope of this
investigative consumer report.
"I authorize the use of any information in this application
to verify my statement, and I authorize past employers,
doctors, all references, and any other persons to answer
all questions concerning my ability, character, reputation,
and previous employment record. I release all such persons
from any liability or damages on account of having furnished
such information.
"I agree to be employed on a 90 calendar days' probationary
period and that I may be dismissed at any time during this
period at the discretion of the employer. I understand that
acceptance of an offer of employment does not create a contractual
obligation upon the employer to continue to employ me in
the future, nor does it create a contractual agreement to
continue rate of pay, status, or benefit plans as were discussed
in advance of my employment.
"Further, I understand that as a condition of my continued
employment, I may be asked to submit to a drug screen test
upon request by the Company, administered at no cost to
me. All medical information will be classified as confidential
with the exception of the positive or negative result of
the drug test. The unsatisfactory results of said test shall
preclude any further consideration of my employment or continued
employment. I also understand that failure to adhere to
Company policy will be considered gross misconduct resulting
in immediate termination and justifying denial of COBRA
benefits. I further agree to submit to blood alcohol and/or
alcohol breathalizer tests upon request by the Company.
"Consequently, I hereby agree to submit to a drug screen
test, and consent to my driving and criminal background
history to be investigated, and authorize the release of
the results to the company."
By clicking on the "Submit" button below, you agree to the
above statement.
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