Employment Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. This is an "At Will" employment position which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. Any offer for employment is subject to applicant successfully passing a drug screen, medical screen, and personal background records check.

Position(s) Applied For			Date of Application
How did you learn about us?
Advertisement	Friend	Walk-In	Clark Employee
Employment Agency	Relative	Other

Last Name *	First Name *	Middle Name

Address *	City *	State *	Zip Code *

Telephone Number(s) *			Cell Phone Number(s)

If you are under 18 years of age can you provide proof of your eligibilty to work? * - REQUIRED	Yes   No
Do you have a current drivers license? Answer only if your job duties include driving a motor vehicle * - ***	Yes   No
Have you ever filed an application with us before? If yes, please give date * - REQUIRED	Yes   No
Have you ever been employed with us before? If yes, please give date * - REQUIRED	Yes   No
Please complete all fields - required fields will be marked
with - REQUIRED or - *** on submission if missing.

	Employment Application
	Have you ever worked in the pest control field or a related industry? * - REQUIRED					Yes   No
	If yes, when?		Where?
	Are you currently employed? * - REQUIRED					Yes   No
	May we contact your present employer? * - REQUIRED					Yes   No
	Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? * - ***					Yes   No
	Proof of citizenship or immigration status will be required upon employment.
	On what date are you available for work? *
	Availability daily?	Full Day	Half Day	3 hrs. or less	Other	* - REQUIRED
	Are you currently on "lay-off" status and subject to recall? * - REQUIRED
	If yes, please explain:					Yes   No
	Have you been convicted of a felony and/or misdemeanor within the last 7 years? * - REQUIRED
	If yes, please explain:					Yes   No
	Education
		Name and Address of school		Course of Study	Years Completed	Diploma or Degree
	High School
	Undergraduate College
	Graduate Professional
	Other Specify

	Employment Application
	Indicate any foreign languages you can speak, read, and/or write.
			FLUENT	GOOD	FAIR
	SPEAK
	READ
	WRITE
	Describe any specialized training, apprenticeship, skills, hobbies, and extracurricular activities:
	Describe any job-related training received in the United States Military:

	Employment Application
	Start with your present or last job, include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.

	Employer 1
			Dates Employed		Work Performed
			From	To
			Hourly Rate/Salary
			Starting	Final
	Employer 2
			Dates Employed		Work Performed
			From	To
			Hourly Rate/Salary
			Starting	Final
	List Professional, trade, business, or civic activities and offices held.

	Employment Application
	Start with your present or last job, include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.

	Employer 3
			Dates Employed		Work Performed
			From	To
			Hourly Rate/Salary
			Starting	Final
	Employer 4
			Dates Employed		Work Performed
			From	To
			Hourly Rate/Salary
			Starting	Final
	Other Qualifications

	Employment Application
	Specialized Skills -- Check Skills/Equipment Operated/Licenses
	10 Key		Drywall		Macintosh		Read/Follow Labels
	Access		Electrical Repair		Managing		Sales - Cold Calls
	Accounting		Email		Measurement Math		Sales - Presentation
	Advertising		Engine Repair		Mechanical Ability		Stucco Repair
	Branch II PC License		Entomology		Microsoft Word		Supervising
	Branch III PC License		Excel		Microsoft Works		Teaching
	Brown Card/Ag License		FilerMaker Pro		PageMill/Go Live		Tile Setting
	Applicator License		Finish Carpentry		Personal Computer		Type 45+ WPM
	Calculator		Framing		Pesticide Application		Vector Control
	Calibration Spray		Fumigation		Phone System		Vehicle Repair
	Claris/AppleWorks		Human Resources		PhotoShop		Weed Control
	Class 1 Driver's License		InDesign		PowerPoint		Woodworking
	Contstruction/Carpentry		Internet		Plumbing Repair		WordPerfect