Employment Application

Fields marked with "*" are required.

Your Name (required)*
Your Email (required)*
Address
Telephone
Position Applied for
How many hours a week do you want to work?
Are you available weekends and holidays?
What days are you available to work? Please mention each day and hour one per line.
Have you ever worked for Service Master PBM of Lincoln before and if so how long ago?

Have you ever done cleaning work before?
If yes, where?

Did you enjoy it?
Why or why not?

Do you currently use illegal drugs?

Do you have dependable transportation?
Do you expect to work here for longer than 6 months?

Do you have supervisory experience?
If yes, where?

Did you enjoy it?
How did you hear about work opportunities here?

List your last 2 employers. (List last one first)

Job 1

Company Name
Type of business
Address,City,State
Phone
Your title
Wage

Dates of employment:

from
to
If you are still employed there, what are your hours?
Describe work done there?
Did you like your job?
Why or why not?
If you have left your job, explain why?
Job 2
Company Name
Type of business
Address,City,State
Phone
Your title
Wage
from
to
Describe work done there?
Did you like your job?
Why or why not?
Why did you leave this job?
Have you ever been in the military?
If yes, in what branch did you serve?
What was your type of discharge?
Indicate your highest grade completed:


High School  1 2 3 4

College  1 2 3 4


Any degrees completed
Where?
Major Study
Have you ever been convicted of?
If so what were they and when did they occur?
(IMPORTANT! Answers to this question will not necessarily keep you from being hired. Factors such as the seriousness and nature of the offense(s) as well as the date and your age at the time of the offense(s) will be taken into consideration. Failure to list a conviction will however be grounds for disqualification of your application, withdrawal of a job offer or termination.)
What are your future plans or goals?
I hereby swear that all information furnished on this application is, to the best of my knowledge, truthful and complete. Also, I hereby consent to undergo a physical examination by a physician appointed by the company, at company expense, should one be requested. I also give my consent to have any references given on this application checked and do consent to the release of requested information by any listed reference. I also consent to have my criminal history checked by this company at any time. I realize that supplying false information on this application or omitting any information asked is grounds for disqualifying my application, rescinding of a job offer or termination of employment.