P & P Home Services, LLC

Applicant Details

Date

How did you hear about us?

Email Address *

Phone Number *

Last Name *

First Name *

MI *

Social Security Number

Are you under 18 years of age?

Position Applied For *

Desired Wage *

Full Address (Street/City/State/Zip) *

How Long at Current Address *

Employment Desired *

When Available to Begin Work? *

Type of School

Name of School

Location

# Years

Major / Degree

High School

College

Bus. Or Trade School

Have you ever been convicted of a crime?

What was the conviction?

A Conviction record will not necessary disqualify you for employment.

Military

Have you ever been in the Armed Forces?

Branch

Are you now a member of the armed forces?

Branch

Specialty

Date Entered

Discharge Date

Do you have any of the following (check all that applies)

Are you able to do the following (Check all able to perform) *

Please clearly state in the box below if you are not able to perform any of the work duties listed above. After reviewing the attached job description, please indicate if you are able to perform the essential functions of the job for which you have applied, with or without a reasonable accommodation. Please write in the box below if you will need any accommodations.

Name of Employer

Job Title

Address (Street/City/State/Zip)

Phone Number

Ending Salary

Supervisor Date

Reason for Leaving

Name of Employer Number

Job Title

Address (Street/City/State/Zip)

Phone Number

Ending Salary

Supervisor Date

Reason for Leaving

References (References can be personal or from previous employers. (References cannot be from relatives)

Name

Phone Number

Can we Contact

In box Below, please write what sets you apart from other applicants (i.e., Unique Skills or Qualifications)

I hereby authorize the potential employer to contact, obtain, and verify the accuracy of information contained in this application from all previous employers, educational institutions, and references. I also hereby release from liability the potential employer and its representatives for seeking, gathering, and using such information to make employment decisions and all other persons or organizations for providing such information.

I understand that any misrepresentation or material omission made by me on this application will be sufficient cause for cancellation of this application or immediate termination of employment if I am employed, whenever it may be discovered.

If I am employed, I acknowledge that there is no specified length of employment and that this application does not constitute an agreement or contract for employment. Accordingly, either I or the employer can terminate the relationship at will, with or without cause, at any time, so long as there is no violation of applicable federal or state law.

We are an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, gender, sexual orientation, national origin, citizenship, age, height, weight, or disability. We assure you that your opportunity for employment with us depends solely on your qualifications.

Thank you for completing this application form and for your interest in P & P Home Services, LLC. If there are any questions, please call P & P Home Services, LLC at (317) 591-9234





Applicant Signature *

Date *