Application for Employment

Application Process Information

Personal Information

We Are An Equal Opportunity Employer

Applications are received and employees are hired without regard to race, creed, color, sex, religion, age, national origin, marital status, physical or mental handicap, disability, sexual orientation, veteran's status, citizenship status, or any other protected classes under state, local or county regulations. The receipt of this application does not mean that job openings exist and does not obligate us in any way. We appreciate your interest in Terminix.

This is a drug-free workplace

Employment Desired

Position:	Bait Checker Branch Manager Carpenter Clerical Customer Service Data Entry Floater Technician IT/Programming Other Sales Sales Scheduling Sales Manager Scheduler Termite Manager Termite Technician Universal Technician
Date You Can Start:
Salary Desired:
Willing to work overtime?	Yes No
Willing to work Saturdays?	Yes No
Were you referred by an employee?	Yes No
Referring Employee Name
How were you referred to us?
Have you been employed here before?	Yes No
If yes, date/position/location?
Are you on a layoff and subject to recall?	Yes No
How much time have you lost from work during the past 12 months?
Are you currently subject to a Non-Compete Agreement or Restrictive Covenant that would prohibit you from working at Terminix in the position for which you are applying?	Yes No

Education

Skills and Qualifications

List any professional, trade, business, or civic activities or offices held that would relate to working here
List any special skills, training, experience, certifications, or licenses that may be relevant to this position or our company
Drivers License Number:
Drivers License State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Birth Date:
Do we have your permission to check with the State on your driving record?	Yes No

Former Employers

References

Work Duties

Please see the specific job description for the position you are applying.

General

Agreement and Release

For the purpose of this agreement and release, the organization that has provided you with this application is referred to as "the company", "this company", or "you". The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application (even if discovered after employment) or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history. financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer a personality profile or other pre-employment tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. I consent to the release of any or all medical information or records deemed necessary to determine my capability to perform the essential job functions of the position for which I may hold.

In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (including their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize past employers, doctors, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted that employment with this company at all times is employment "at will". It is further understood that this "at will" relationship may not be changed by any written document, verbal statements, or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my "at will" employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period.

I have read, understand, and by my signature consent to these statements.

I accept the above agreement Yes No