Personal Information:

Full name

Address

Phone

Have you ever used another name?

If hired, can you show proof that you are authorized to work in the United States?

If hired, can you show proof that you are over 18 years old?

Position Applied for (If you are approved for the position, what are your salary / hourly rate requirements?)

Have you ever been discharged from any position?

discharged If Yes why?

Background

Have you ever been convicted of or pled guilty to any crime (including traffic violations)? Yes or No?If so, please list nature, date, and location of offense(s). The Company will not deny employment to any applicant solely because the application has been convicted of an offense. The Company, however, may consider the nature, date, and circumstances of the offense, as well as whether the offense is related to the job duties of the position sought:

Are you currently out on bail, the subject of a current warrant for arrest, or released on your own recognizance pending trial for any
offense (including traffic violations)? Yes or No?If so, please list nature, date, and location of alleged offense(s), and the status of the case:

Education and Experience

Please list each school you have attended, dates of attendance, and grade or diploma attained:

Please list all professional licenses, training courses that you have completed, and any other qualifications for the position:

Please list all prior employers for the last 10 years, including dates of employment, rate of pay, and position held:

Are you a military veteran?

If yes, honorable discharge?

Work Availability

If you are accepted for the position, what day can you begin work?

Do you have any objection to working overtime?

Can you work overtime with no prior notice?

Can you work on Saturday and/or Sunday if required by the position?

Can you work full-time?

Part-time?

Job Description and Qualifications

Can you perform the essential functions of the job with or without reasonable accommodation?

Do you have any physical or mental limitations, pre-existing physical or mental conditions, or prior injuries, that may interfere with
your ability to perform the duties of the position sought? If so, please describe the nature of the limitation, condition, or prior
injury.

I hereby understand and acknowledge the following statement: “Misrepresentations as to pre-existing physical or mental conditions may void your workers’ compensation benefits.”I hereby understand and acknowledge that Home and Commercial Services, LLC, is an Equal Opportunity Employer,that makes employment decisions without regard to race, color, sex, religion, national origin, age, disability, sexual orientation, or marital status. I further understand and acknowledge that this Company complies with the Americans with Disabilities Act, and that the Company reasonably accommodates qualified individuals with disabilities and bonafide religious beliefs. I further understand and acknowledge that, during the interview process, I may be asked questions concerning my ability to perform job-related functions.Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Home and Commercial Services, LLC, and its designated representatives and agents to conduct a comprehensive review of my background through a consumer report and/or investigative consumer report to be generated for employment, promotion, reassignment, or retention as an employee. I understand the scope of the consumer report / investigative consumer report may include, but is not limited to, the following areas: verification of Social Security Number, current and previous residences, employment history,references, credit history, criminal history (including traffic offenses in any jurisdiction), birth records, motor vehicle records (including traffic citations and registration), and any other records permitted by law. I authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decisions. I hereby authorize and request any present or future employer school,police department, financial institution, or other persons having personal knowledge of me to furnish Home and Commercial Services, LLC, or its designated agents, with any and all information in their possession regarding me in connection with my application for employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as original. I hereby release Home and Commercial Services, LLC, and its agents,representatives, and assigned agencies, both individually and collectively, from any and all liability for damages of any kind, which may at any time result to my heirs, family, or assigns, because of compliance with this authorization and request to release. I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to betaken based upon the consumer report, a copy of the report and a summary of the consumer’s rights will be provided tome.

References

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This application form is intended for use in evaluation your qualifications for employment. This is not an employment contract. Please note that any false or misleading statements made during the interview process or on the application or other company forms are grounds for immediately terminating the interview process, any conditional offer of employment, or employment after hiring. All qualified applications will receive consideration without regard to any status or condition protected by law. A conviction will not necessarily bar an applicant from employment. If you appear to be qualified for the position applied for based upon the information on your application form and/or job interview, the Company may make a conditional offer of employment contingent upon submitting to the Company’s substance abuse testing and the verification of your answers to any requested information through reference and background checks. If you receive a conditional job offer, your conditional job offer may be rescinded if the Company’s substance abuse testing indicates that you are not in compliance with the Company’s substance abuse policy or if reference and background check information reveals information that leads the Company to believe the employment offer should be withdrawn.

In the event that you are hired for a position with the Company, you acknowledge (a) that your employment is terminate at will, either by yourself or the Company at any time for any lawful reason, and (b) that no contract or employment other than “at will” has been expressed or implied”, and that no circumstances arising out of your employment will alter your “at will” employment relationship unless expressed in writing.

I certify that I have read and understand the instructions and information on this application form and all other forms that have beengiven to me by the Company.

I authorize the Company and its agents to verify any information that I have provided and to investigate my background and allstatements contained in this employment application as may be necessary to arrive at an employment decision. I authorize all currentand former employers, persons, educational institutions, companies, and/or law enforcement authorities to release any informationconcerning my background. I hereby release and hold harmless all such current and former employers, persons, schools, companies,law enforcement authorities, and Home and Commercial Services, LLC, from any liability or damages whatsoever for attempting to,obtaining, providing, or using such information.

I understand that employment is not for any guaranteed term and may be terminated by the Company or employee at any time for any reason. I further understand that this “at will” employment relationship may not be changed by any written document, verbal statement, or conduct unless such change is specifically acknowledged by an authorized executive of the Company in writing.

In the event of employment:

I understand that false, misleading, or omitted information given in my employment application, interview(s), or any other document or statement may result in discharge.
I understand that I am required to abide by all rules and regulations of the Company
I understand that Home and Commercial Services, LLC., is committed to providing a drug-free workplace and that a positive drug test result may be grounds for termination of employment.
I understand that I will be subject to a 90-day introductory probation period and that during this time frame I may be release at any time for any reason other than for any status or condition protected by law.