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 1234

    College 1234


    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.