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APPLICANT INFORMATION

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* Are you a citizen of the United States?:

  • YesNo

If no, are you authorized to work in the U.S.?

  • YesNo

* Have you ever worked for this company?

  • YesNo If so,when?

* Have you ever been convicted of a felony?

  • YesNo If Yes,Explain?

Select

  • Full TimePart TimeAny

Education

  • YesNo
  • YesNo
  • YesNo
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PREFERENCES

Please List Three Professional references:

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PREVIOUS EMPLOYMENT :

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MILITARY SERVICE

DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.

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Application Availability Form

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**Be sure that you are precise when filling out the days and times you are available because on any given day, you may have to work a day,
or time outside of your normal schedule. Please be advised that by limiting yourself to certain days and times, you may also be limiting yourself to certain opportunities. Days and times of the week you are available:

  • YesNo

I fully understand that I will be expected to work the available times that I have listed above. In the event I cannot work the times that I have listed above may result in my termination of employment with PCMS.

Applicant's Statement and Conditions of Employment
(Please read carefully before signing)

I understand that an investigative consumer report involving information concerning my character, employment history, general reputation, police record, personal habits, mode of living, credit rating and indebtedness may be obtained prior to any final offer of employment. Upon a timely written request to the personnel department of the company, the nature and scope of the report will be disclosed to me.

I certify that the answers given by me in this employment application are true, correct and complete. I agree that the company shall not be liable, in any respect, if my employment is terminated because of misstatements or pertinent omissions made by me in this application, Moreover, I understand that all offers of employment are contingent upon passing the company's prescribed physical examination, drug screening, and background check.

I agree, as a condition of my employment (should I be employed by the Company), to submit to a medical examination if requested and based on the position that I accept, I further agree to the search or examination of myself or personal property while on the company's premises or while conducting its business elsewhere. I also authorize any company, school, police or security personnel, or other person to give any information regarding my employment, habits, ability, or any other characteristics whatsoever; together with any information they have regarding me whether or not it is in their records. I hereby release all physicians, examiner, companies, schools, or other persons from liability for any damages whatsoever for such testing, examining, or issuing this information. It is agreed and understood that completion of this application does not mean a job opening exists and in no way obligates the company to employ me.

In the event of employment, I will comply with all company rules and regulations as established from time to time including the company's substance abuse policy. I am willing to work all assigned overtime or other special work assignments that is requested by the company. Furthermore, since the company does not offer contract of employment (unless signed by the President), I understand that nothing contained herein is intended to create a contract between the company and me for either employment or the provision of any compensation or benefits. I understand that I have the right to terminate my employment at any time and likewise, the company has the same right.

I hereby understand and acknowledge that any employment relationship with this Company is of an "At-Will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time, with or without notice, and with or without cause. It is further understood that this "At-Will" employment relationship may not be changed by any written document or verbal agreement unless such change is specifically acknowledged in writing by an authorized Executive of this Company. I also understand that PROFFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC retains the right to amend, modify, add, or delete any or all policies or procedures at its sole and absolute discretion.

During my employment with PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC and after my employment ends, I agree not to disclose any confidential or proprietary information regarding operating and trade secrets. I further agree that with respect to any civil litigation involving PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC in which I am a potential witness and which does not involve an actual or potential claim by me personally, I will not discuss the facts of the case

with any third parties without first notifying PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC or unless a representative or attorney of PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC is present. A copy of this form may be used as the original. The use of results from this form and/or tests will be used for prudent employment decisions.

This application is valid for sixty days from the application date unless renewed in person or in writing.

It is unlawful in Louisiana to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability..

Under Louisiana law, an employer may not require or demand, as a condition of employment, prospective employment, or continued employment, that an individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.00

PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC

Background Check / Drug Consent / Special Testing

The policy of PCMS requires that each potential employee has a criminal background search performed before official employment is offered. Also, each potential employee will have to take a drug screen to promote a drug free work environment. PCMS will pay for each potential employee's background check and drug screen. However, in the event an employee resigns within his or her 90 day probationary period, without a minimum 5 day written notice, he or she will be responsible for the cost of the drug screen. In the event an employee is terminated within his or her 90-day probationary period he or she will be responsible for the cost of the drug screen. Also, in the event you need special medical testing such as a TB test, PCMS will pay for your test, but if you resign your position with-in 90-days without a minimum of a 5-day notice you will be responsible for the cost of any special testing paid for by PCMS. The charges will be deducted from your last and final paycheck. You will be informed of the total charges that will be deducted out of your final paycheck.

BACKGROUND CHECK AUTHORIZATION

After carefully reading the Background Check Disclosure form, I authorize the Company to order my background report, including investigative consumer reports. I understand that the Company may rely on this authorization to order additional background reports, including investigative consumer reports, during my employment without asking me for my authorization again as allowed by law.

I also authorize the following agencies and entities to disclose to Compliance Background Screening Services (CBSS) and its agents all information about or concerning me, including but limited to: my past or present employers; learning institutions, including colleges and universities; law enforcement and all other federal, state and local agencies; federal, state and local courts; the military; credit bureaus; testing facilities; motor vehicle records agencies; if applicable, workers' compensation injuries; all other private and public sector repositories of information; and any other person, organization, or agency with any information about or concerning me. Workers' compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. The information that can be disclosed to Compliance Background Screening Services (CBSS) and its agents includes, but is not limited to, information concerning my employment history, earnings history, education, personal references, credit history, motor vehicle history, criminal history, military service, professional credentials and licenses and substance abuse testing.

I agree the Company may rely on this authorization to order background reports, including investigative consumer reports, from companies other than Compliance Background Screening Services (CBSS) without asking me for my authorization again as allowed by law. I also agree that a copy of this form is valid like the signed original. I certify that all of my personal information on this form is true and correct and understand that dishonesty may disqualify me from consideration for employment wtth the Company, or if I am hired or already work for the Company, that my employment may be terminated.

  • Yes
  • No
  • Not Employed:

FOR IDENTIFICATION PURPOSES ONLY:

  • MaleFemale
  • AsianAfrican-AmericanCaucasianHispanicOther

Current Address:

Below, Please List Cities and States Of Residence For The Past Ten Years:

If You Live Or Work For The Company In California,Minnesota Or Oklahoma:Check This Box If You Would Like A Free Copy Of Your Report:

BACKGROUNGD CHECK DISCLOSURE

This disclosure shall serve as notification that PCMS (the "Company") may request a consumer report or investigative consumer report on you in connection with your application for employment. If hired, or if you already work for the Company, additional reports, consistent with current or future job description, may be requested on you to determine your suitability for continued employment.

Consumer reports will be prepared and supplied to the Company by Compliance Background Screening Services (CBSS). Compliance Background Screening Services (CBSS) can be reached at 888-959-5242 (Compliance Dept. Ext. 1) Their privacy policy may be found at CBSS Privacy Policy.

A consumer report (background check) contains information regarding your character, general reputation, mode of living, personal characteristics, and credit standing. An investigative consumer report is a type of consumer report that includes information from personal interviews with friends, neighbors and associates, except in California where that term means any background repon that is not a credit report. The nature and scope of the most common type of investigative consumer report is an investigation into your education and/or employment hiHory conducted by Compliance Background Screening Services (CBSS) or another outside organization. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting Compliance Background Screening Services (CBSS). A summary of your rights under the Fair Credit Repos:ing Act is being provided to you with this form.

As directed by company policy and consistent with your job description, the types of information that may be requested on you inciude but are not limited to: court records, driving record, employment and wage history, education, credentials and licensing, credit, worker's compensation claims, Social Security number verification, pewonal references, and drug testing results. Worker's compensation information will only be requested in compliance with federal Americans with Disabilities Act and/or any other applicable federal, state or local laws and only after a conditional job offer is made. Credit history wi{l only be requested when permitted by law and where such information is substantially related to the duties and responsibilities of the position for which you are applying. The information may be obtained from public and private sources.

The Fair Credit Reporting Act gives you specific rights in dealing with consumer reporting agencies. You will find these rights summarized on A Summary of Your Riehts Under the Fair Credit Reoortine Act and A Summary of Your Rights Under the Provisions of California Civil Code Section 1786 22 as provided here.

STATE SPECIFIC NOTICES

If you live or work for the Company in the states listed below, please note the following:

CALIFORNIA: You may view the file that Compliance Background Screening Services (CBSS) has for you, and order a copy of the file, upon submitting proper identification and paying copying costs, by coming to their offices, during normal business hours and on reasonable notice, or by mail. You may also ask for a file-summary by telephone. Compliance Background Screening Services (CBSS) can answer questions about information in your file, including any coded information. Ifyou come in person, another person can come with you, so long as that person can show proper identification.

MAINE: If you ask us, you have the right to Know whether the Company ordered an investigative consumer report on you. You may request the name, address, and telephone number of the nearest office for Compliance Background Screening Services (CBSS). You will get this information within 5 business days of our receipt of your request. You have the right to ask Compliance Background Screening Services (CBSS) for a free copy of the report.

MARYLAND: He Company obtains credit history information on you, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

MASSACHUSETTS/NEW JERSEY: If you submit a request to us in writing, you have the right to know whether the Company ordered an investigative consumer report from Compliance Background Screening Services (CBSS). You may inspect and order a free copy of the report by contacting Compliance Background Screening Services (CBSS).

MINNESOTA: If you submit a request to us in writing, you have the right to get from the Company a complete and accurate disclosure of the nature and scope of the consumer report or investigative consumer report ordered, if any.

NEW YORK: lf you submit a request to us in writing, you have the right co know whether the Company ordered a consumer report or an investigative consumer report from Compliance Background Screening Services (CBSS), and you will be provided with the name and address of Compliance Background Screening Services (CBSS). You may inspect and order a free copy of the reports by contacting Compliance Background Screening Services (CBSS). A copy of Article 23A of the New YorK Correction Law is being provided with this form.

OREGON: If the Company obtains credit history information on you, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

WASHINGTON STATE: If you submit a request to us in writing, you have the right to get from the Company a complete and accurate disclosure of the nature and scope of the inveWigative consumer report we ordered, if any. You also have the right to ask Compliance Background Screening Services (CBSS) for a written summary of your rights under the Washington fair Credit Reporting Act. If the Company obtains information bearing on your credit worthiness, credit standing or credit capacity, it will be used to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being considered.

A Summary of Your Rights Under the Fair Credit Reporting Act:

The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of oonsumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and speciaIt)/ agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.

  • You must be told if information in your file has been used against you.Anyone who uses a credit report or another type of consumer report to deny yer application br credit, insurance, or employment - or b take another advent action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.
  • You have the right to know what is in your file.You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disdosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
  • a person has taken adverse ac#on against you because of information in your credit report;
  • you are the victim of identty theft and place a fraud alert in your file;
  • your file contains inaccurate information as a result of fraud;
  • you are on public assistance;
  • you are unemployed but expect to apply for employment within 60 days.

    In addition, all consumers are enbeded D one free diMosue every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.

  • You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute scores used in residental real property loans, but you will have to pay for it. In some mortgage transactons, you will reoeive credit soore information for free from the mortgage lender.
  • You have the right to dispute incomplete or inaocurate information. If you identfy information in your file that is incomplete or inaccurate, and report it to ttie consumer repoiting agency, the agency must investigate unless your dispute is frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
  • Consumer reporting agencies must coriect or delata inaccurate, incofripBte, or unveriflabls infomiation. Inaccurate, irxxxnplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting agency may continue to report informaton it has verified as accurate.
  • Consumer reporting agencies may not report outdated negative information. In most cases, a oonsumer reporting agency may not report negative information that is more than seven yean old, or bankruptcies that are more than 10 years old.
  • Access to your file is limited. A consumer repoiting agency may provide informaton about you only to people with a valid need - usually to consider an application with a creditor, insurer, employer, landlord, or other business. The F '.RA specifies those with a valid need for access
  • You must give your content for repoM to be provided to employers. A consumer reporting agency may not give out information about you to your employer, or a potental employer, without your written consent given bttie employer. Written consent generally is not required in the tracking industry. For more information, go to www.consumerfinance.gov/learnmore
  • You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited ”prescreened" offers for oedit and insuranoe must indude a toll-free phone number you can call if you choose to remove your Name and address from the lists these offen ae based on. You may opt-out with the nationwide credit bureaus at 1-88&567-8688.
  • You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a fumisher of informaf on to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
  • Identity theft victims and active duty military personnel have additional rights. For more information, visit
    www.consumerfinance.gov/learnmore

States may enforce the FCRA, and many states have their own consumer reporting laws. In soitie cases, you may have more rights uiider state law. For mora information, contact your state or local consumer protection agency or your state Attorney General. For infontiation about your federal rights,contact:

  • TYPE OF BUSINESS:
  • CONTACT:
  • 1. a. Banks, savings associatoris, and credit unions with total assets of ver $10
    billion and their affiliates.

    b. SP aftliates thet are not banks,savings associations, or credit unions also
    should list in addition to the CFPB:

  • a. Consumer Protection Financial Bureau
    1700 G Street N.W.
    Washington,DC 20552

    b. Federal Trade Commission: Consumer Response Canter - FCRA
    Washington,DC 20580
    (877) 382-4357

  • 2. To the extent not included in item 1 above:

    a. National banks, federal savings associations,and federal branches
    and federal agencies of foreign banks

    b. State mamber banks,branches and agencies of foreign banks(other than
    federal branches federal agencies and Insured State Branches of Foreign
    Banks)commercial lending companies owned or controlled by foreign banks
    and organization operating under section 25 or 25A of the Federal Reserved
    Act.

    c. Nonmember Insured Banks, Insured State Branches of Foreign Banks,and
    insured sale savings associations

    d. Federal Credit Unions

  • a. Office of the Comptroller of the Currency
    Customer Assistance Group
    1301 McKinney Street,Suite 3450
    Houston, TX 77010-g050

    b. Federal Reserve Consumer Help center
    P.O. Box 1200
    Minneapolis MN 55460

    c. FDIC Consumer Respons Center
    1100 Walnut Street,Box #11
    Kansas City, MO 64106

    d. National Credit Union Administration
    offce of Consumer Protection (0CP)
    Division of Consumer Compliance and 0utreach (DCCO)
    1775 Dukee Street
    Alexandria, VA 22314

  • 3. Air Carriers
  • Asst. General Counsel for Aviation Enforcement & Proceedings
    Aviation Consumer Protection Division
    Department of Transportation
    1200 New Jersey Avenue,S.E.
    Washington,DC 2O590
  • 4. Creditors Subject to Surface Transportation Board
  • Office of Preceedings, Surface Transportation Board
    Department of Transportation
    395 E Street,S.W.
    Washington. DC 20423
  • 6. Small Business Investment Companies
  • Associate Deputy Administrator for Capital Access
    United States Small Business Administration
    409 Third Street,SW,8th Flgor Washington, DC 20416
  • 7. Brokers And Dealers
  • Securities and Exchange Commision
    100 F Street, N.E.
    Washington, DC 20549
  • 8. Federal Land Bank, Federal land Bank Associatons Federal Intermediate
    Credit Banks and Production credit Associatons
  • Farm Credit Administration
    1501 Farm Credit Drive
    McLean, VA 22102-5090
  • 9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
  • FTC Regional office for region in which the creditor operates or
    Federal Trade Commission: Consumer Response Center---FCRA
    Washington DC 20580
    (877) 382-4357