Employment Application

Application Information

Incomplete information could disqualify you from further consideration. Please complete all fields.

First Name

Last Name

Date

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone/Mobile

Are you eligible to work in the U.S?

Yes

Are you at least 18 years or older? (If no, you may be required to provide authorization to work.)

Yes

Have you ever been terminated from employment or asked to resign by an employer?

Yes

If yes, please provide company names and details

Can you work any shift?

Yes

If no, explain

Can you work overtime, including weekends?

Yes

Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

Yes

Employment Desired

Date You Can Start

Hourly Rate/ Salary Desired

Position Desired

Are You Currently Employed?

If so, may we inquire of your present employer?

Education

High School

Degree Received

Subjects Studied/Major

College or University

Degree Received

Subjects Studied/Major

Trade, Business or Correspondence School

Degree Received

Subjects Studied/Major

Employment History

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

From

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason For Leaving

From

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason For Leaving

From

Employer Name

Phone

Job Title

Address

Immediate Supervisor and Title

Summarize the nature of work performed and job responsibilities

Reason For Leaving

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?

Yes

If yes, explain

References

Give the names of three persons not related to you, whom you have known at least three (3) years.

Name

Address, Phone, Email

Company

Year Acquainted

Name

Address, Phone, Email

Company

Year Acquainted

Name

Address, Phone, Email

Company

Year Acquainted

Please read carefully before signing

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Super Home Services to hire me. If I am hired, I understand that either Super Home Services or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of Super Home Services has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to Super Home Services is true and complete information on this application. No requested information has been concealed. I authorize Super Home Services to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Date

Name