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Employment Application
HOME
ABOUT
RESIDENTIAL
COMMERCIAL
PEST LIBRARY
CONTACT
Step
1
of
6
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Name
First
Last
Address
Street Address
City
State / Province / Region
ZIP / Postal Code
Email
Phone
Desired Position
Field Technician
Office Staff
How did you hear about us?
Are you at least 18 years of age?
Yes
No
Salary desired
If hired, can you provide proof of U.S. citizenship or proof of your legal right to work in the U.S.?
Yes
No
Date available to start
MM slash DD slash YYYY
Desired hours
Full-time
Part-time
High School – list school name, address and graduation year
College – list school name, address and graduation year(s)
Below list all present and past employers over the past ten years, starting with your most recent employer. You must complete this section even if attaching a resume.
May we contact your current employer?
Yes
No
1.) Employer Name
Start date
MM slash DD slash YYYY
End date
MM slash DD slash YYYY
Position
Supervisor name and number
Salary
Reason(s) for leaving
2.) Employer Name
Start date
MM slash DD slash YYYY
End date
MM slash DD slash YYYY
Position
Supervisor name and number
Salary
Reason(s) for leaving
3.) Employer Name
Start date
MM slash DD slash YYYY
End date
MM slash DD slash YYYY
Position
Supervisor name and number
Salary
Reason(s) for leaving
ADDITIONAL INFORMATION
Licenses – professional, trade or business
List any languages you speak other than English (please put n/a for no other languages)
Have you been convicted of Driving Under the Influence “DUI” in the last 7 years? (put N/A if applying for office position)
Yes
No
N/A
Do you have a reliable means of transportation to and from work? (put N/A if applying for field technician position)
Yes
No
N/A
If hired, would you be able to work overtime as needed?
Yes
No
Have you ever been convicted of a felony or misdemeanor? If yes, please explain.
REFERENCES
List three persons not related to you who have knowledge of your work performance within the last 5 years.
1.) Name
First
Last
Company
Phone
Email
Relationship
Years acquainted
2.) Name
First
Last
Company
Phone
Email
Years acquainted
Relationship
3.) Name
First
Last
Company
Email
Phone
Years acquainted
Relationship
ACKNOWLEDGEMENTS
Consent
I understand that the Company is an Equal Opportunity Employee that desires to maintain a work environment that is free of sexual harassment and discrimination due to race, religion, color, national origin, physical or mental disability, age or any other status protected by Federal, State or local laws. The Company will make reasonable efforts to accommodate physical or mental limitations of an otherwise qualified employee unless undue hardship would result for the company.
Consent
I do not understand. Please provide more information.
Consent
I understand if I am offered a position with the Company, I will required to submit to a drug/alcohol test and failure to pass the test means I will not be employed by this company. Negative test results are required as a condition of employment.
Consent
I do not understand. Please provide more information.
Consent
I understand if I am offered a position with the Company, I will required to submit to a drug/alcohol test and failure to pass the test means I will not be employed by this company. Negative test results are required as a condition of employment.
Consent
I do not understand. Please provide more information.
Consent
I hereby certify that I have not knowingly withheld any information that could adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I certify that I have personally completed this application. I understand that any omission or misstatement of fact on this application, or any other document used to secure employment, shall be grounds for rejection of this application or for immediate termination if I am employed, regardless of the time elapsed before discovery.
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