Chem-Wise Ecological Pest Management, Pest Control and Pest Extermination Services

Name & Location of School

Have you ever been convicted of a misdemeanor or felony? Yes No
If Yes, Explain:

List any driving violations in the last five years:

Legal History

Application For Employment

General Information
Subjects of Special Study/Research Work or Special Training/Skills

Rank

Date
Month and Year
From

Salary

Reason For Leaving

Addr

Business

Years Attended

Did You Graduate?

Years Known

Authorization
   By entering submit "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
    I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.
    I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
    This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

ess

Name

References Give Below the Names of Three Persons Not Related to You, Whom you have Known at Least One Year

Position

Name & Address of Employer

To
From
To
From
To
From
To

Former Employers (List Below Last Four Employers Starting with the Last One First)

U.S. Military Or Naval Services

Personal Information:
Name (Last Name First)

Present Address                                           City                                             State              Zip

Permanent Address                                     City                                             State              Zip

Phone Number                                                        Referred By


Employment Desired
Position                                                                       Date You Can Start                Salary Desired


Are you Employed?    If so, may we inquire of your present employer?
Ever applied to this company before? Where? When?

Education History

Grammar School

High School

College

Trade Business or Correspondence School