Careers | Newburgh, IN | Pass Pest Control

First Name

Last Name

Today's Date

Phone Number

Alternate Phone Number

Current Address

Are you over the age of 18?

Are you currently eligable to work in the US?

Can you provide documentation that you are legally eligible to work in the U.S.?

Position applying for

Date available to work

Desired type of employment

Desired Shift

Desired salary or rate of pay

Availability

Start Time

End Time

Can you perform the essential job functions for which you are applying, with or without reasonable accommodation?

Have you ever held a position of trust (handling money or confidential material)?

Do you have reliable transportation to work?

Have you ever been discharged or asked to resign?

Do you have any friends or relatives that currently work here?

Have you ever been bonded?

Why do you desire to make a change?

Have you ever been refused bond?

Does your present employer know of your plans to change employment?

Education Information

High School

Name of Institution

Degree Received (with major)

Location

Years Completed

College or Trade School

Name of Institution

Degree Received (with major)

Location

Years Completed

Graduate School

Name of Institution

Degree Received (with major)

Location

Years Completed

Applicable licenses

Prior Work Record

Name of Most Recent Employer

Business Number

Immediate Supervisor (Name & Position)

Hire Date

End Date

Job Title & Duties

Reason for Leaving

May we contact the employers listed above?

If not, indicate which one(s) you do not wish us to contact

Application

The facts set forth above in my application for employment are true and complete. I understand that if employed, false statements or omission of information on this application, a resume, or other applicant information provided may be considered sufficient reason for dismissal. I understand that consumer reports which may contain public record information may be requested from the reporting agency. These reports may include information as to my character, work habits, performance, and experiences along with reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various federal, state, and other agencies which maintain records concerning my past activities relating to my driving, credit, criminal, civil, and other experiences. I understand that I have the right to make a written request within a reasonable period of time to receive additional 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 statements, and I authorize the past employers, all references, and any other persons to answer all questions asked 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 understand that employment at this organization is on an "at will" basis, and includes no guarantee, contract, or promise of employment for any specific length of time.

Signature of Applicant

Today's Date

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