Application For Employment

Position Applying For:*

PERSONAL: First Name:* Middle:* Last Name:*
E-Mail:*
Address:* City:* State:* Zip:*
Primary Phone:* ( ) - Secondary Phone: ( ) -
Date of Birth:*
Drivers License Number:* State:*
Are you age 18 or older?* Yes No
Are you legally authorized to work in the US?* Yes No
Date available to begin employment:*
Availability:* Full Time Part Time

EDUCATION:

	Name & Address	Graduate?	Years Attended
High School*
College(s)
Graduate School
Tech, Business or Other

EMPLOYER #1(Most Recent) Month Started:* Year Started:*          Month Left: Year Left:
Employer:*         Employer Address:
Phone Number:*           Supervisor:*
Position/Title:*
Reason for leaving: *
May we contact your present employer?* Yes   No

EMPLOYER #2 Month Started: Year Started:          Month Left: Year Left:
Employer:         Employer Address:
Phone Number:         Supervisor:
Position/Title:
Reason for leaving:

EMPLOYER #3 Month Started: Year Started:          Month Left: Year Left:
Employer:         Employer Address:
Phone Number: Supervisor:
Position/Title:
Reason for leaving:

EMPLOYER #4 Month Started: Year Started:          Month Left: Year Left:
Employer:         Employer Address:
Phone Number: Supervisor:
Position/Title:
Reason for leaving:

REFERENCES: Please list the names of persons (excluding family) willing to provide professional or character references.

REFERENCE #1 Name:* Occupation:* Phone Number:*
Address:* Relationship:*

REFERENCE #2 Name:* Occupation:* Phone Number:*
Address:* Relationship:*

REFERENCE #3 Name:* Occupation:* Phone Number:*
Address:* Relationship:*

BACKGROUND INFORMATION Have you been arrested, convicted of, or pled guilty to or no contest to ANY crime?*Yes No
If yes, please include dates, locations and results of conviction.

EMERGENCY CONTACT INFORMATION Name of nearest relative:* Relationship:*
Address:* Phone Number:*

Are there any conditions that you have that we need to know about that would have to be treated in an emergency?*
(I.E. asthma, bee allergies, diabetes)

ADDITIONAL INFORMATION Any additional comments:

EMPLOYMENT PRE-SCREEN QUESTIONS

We work in all kinds of weather. The very nature of our business requires employees to be diversified and be able to inspect crawlspaces and inspect attics of homes and businesses.

Please take the time to fill out this pre-assessment for the application process. Answer the questions honestly, completely and to the best of your ability.

Why are you interested in working for our company?*

Are you able to pass a drug screen and a background check?*
Yes    No

Do you have reliable transportation?*
Yes    No

Can you fully understand written directions?*
Yes    No

Can you follow simple oral directions?*
Yes    No

When are you able to start?*

Working for our company means we need reliable, ethical and responsible employees. In your own words, tell us what this means to you and how this would apply to your job.*

The position is 20-30 hours a week and one evening per week will be required. How flexible are you with your schedule?*

The position may evolve into full-time. Is this something that you would be interested in?*
Yes    No

Do you have any outside or extra-curricular activities that may interfere with a normal work schedule? Our work days can start as early as 6 AM and end as late as 10 PM. Please explain.*

If hired for clerical/office work, would you be willing to do some pest control work as needed? Such as checking monitoring stations and spraying/baiting for pest control. (If you are applying for sales technician or service technician position, please choose N/A.)*
Yes    No    N/A

Are you willing to go into crawlspaces or attics as required?*
Yes    No

Do you have any disabilities that would make working in crawlspaces and attics difficult?*

Are you able to make calls to customers to set renews, and sometimes call our (dead) customers to try to bring in business?*

How able are you to learn new software applications and new techniques applicable to your position?*

Are you able to talk with customers for collections and to schedule appointments?*
Yes    No

How familiar are you with Gaston County and surrounding areas?*

Do you have any allergies related to bees, ants, wasps, or other insects you may need to carry an epinephrine pen ("epi")? If so, do you have one? Do you know where to purchase one?*

Does heat/cold or changes in weather adversely affect your productivity? If so, explain.*

By digitally signing this application you are agreeing to give DellPest Exterminating and its representatives authority to research your background and obtain all pertinent data that is relevant to the employment process. If at any time during screening or after obtaining employment with DellPest it is ascertained that falsification occured on this application, employment or the offer of employment may be withdrawn at the discretion of DellPest.

*Please type your full name (including middle name or inital).