Employment Application - ServiceMaster by Request

Date Submitted:*

Name*

First Middle Last

Social Security #:*

Address*

Street Address Address Line 2 City State ZIP Code

Telephone Number:*

Cell Number:

Email:*

Position Applying For: (Check those of interest)*

Janitorial
Carpet Cleaning
Floor Maintenance
Window Cleaning
Administrative
Sales
Other, Specify

Other:*

Method of Referral:

Employee Name:*

If under 18 years old, can you provide a work permit?*

Yes
No

Were you previously employed by this company?*

Yes
No

Position held and dates employed:*

Do you have a legal right to work in the U.S.?*

Yes
No

Have you been convicted of a felony other than a traffic violation?*

Yes
No

Give all dates and reasons for conviction. (Will not necessarily disqualify you from position.):*

Employment Status Desired:*

Full-Time
Part-Time
Temporary

What hours are you available for work?:*

Select All
1st Shift
2nd Shift
3rd Shift

Employment History

Place a check mark by the employer’s you do not want us to contact. List your most recent employers first.

Can we contact this employer?

Yes
No

Employer Name:

Address:

Dates Employed: (From/To)

Job Title:

Work Performed:

Pay Rate (Hourly/Salary):

Supervisor:

Reason for Leaving:

Can we contact this employer?

Yes
No

Employer Name:

Address:

Dates Employed: (From/To)

Job Title:

Work Performed:

Pay Rate (Hourly/Salary):

Supervisor:

Reason for Leaving:

Can we contact this employer?

Yes
No

Employer Name:

Address:

Dates Employed: (From/To)

Job Title:

Work Performed:

Pay Rate (Hourly/Salary):

Supervisor:

Reason for Leaving:

Explain any gaps in employment other than those due to personal illness, injury, or disability:

Have you ever been fired or asked to resign from a job?*

Yes
No

High School

Name of School:

Location:

Course of Study:

Did your Graduate?

Yes
No

Degree or Diploma:

Years Completed:

College, Business School, Vocational School/Other Trade School

Name of School:

Location:

Course of Study:

Did your Graduate?

Yes
No

Degree or Diploma:

Years Completed:

Continuing Education:

Skills and Qualifications

List any special training, skills, experience, or training that you possess related to the position applied for:*

List any equipment or machines you have experience with or are certified to operate:*

Employee References

List names and telephone numbers of three business/work references who are not related to you.

List*

Name:	Ocupation:	Address	Phone Number:

Preliminary Screening Questionnaire

What skills do you possess that you could apply to this position?*

Do you have reliable transportation?*

What days/shifts are you available for work?*

How many pounds can you lift?*

Can you work in areas that expose you to significant levels of dust?*

How has your attendance been?*

The physical requirements for this position are: standing and walking for long periods of time, lifting, pulling, pushing, bending, stooping, carrying, and constant movement. Do you feel that you can meet these requirements?*

It is a condition of employment that all candidates who are offered a position, must pass a criminal background check and a pre-employment drug test. Is there anything relative to those two items that we would need to discuss in advance?*

Referral Method:*

Equal Opportunity Employer Acknowledgement

It is our policy to abide by all federal and state laws prohibiting employment discrimination on the basis of a person’s race, color, national origin, religion, age, gender, or disability except where bonafide occupational qualification exists.

Applicant Certification Please read carefully before signing. If you have any questions regarding the following statements, please call 814-317-5136.

I certify to the best of my knowledge, the answers provided by me and the statements made by me in this application are correct and complete. I understand that any false information contained in this application may result in my discharge from employment. I understand the acceptance of any offer of employment does not create a contractual relationship or definite term of employment. If hired I will be an at-will employee, and my employment may be terminated by Ryan Professional Maintenance Services, LLC or by me at any time with or without cause.

Any employment offer may be contigent upon the successful completion of a pre-employment physical examination and drug/alcohol screening. I hereby authorize the release to Ryan Professional Maintenance Services, LLC all reports and recommendations resulting for such examinations. I acknowledge that a series of background investigations may be conducted including: employment references, education verification, motor vehicle record, and criminal conviction searches (security checks). I understand that I may be subject to random or reasonable suspicion drug or alcohol screening.

Applicants E-Signature:*

Date:*