APPLICANT INFORMATION Referral Source:IndeedLA WorksUL Job BoardSLCC Job BoardEmployee ReferralWord of Mouth Last Name* First Name* MI Email :* Phone :* Date* Street Address* Apartment/Unit# City* State* Zip/Code* Date Of Birth* Have you worked for PCMS in the past, if so when. This is a requirement as well* Date Available* Desired Salary* Position Applied For:* * 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? Yes, If so,when?No * Have you ever been convicted of a felony? Yes, If Yes,Explain?No Education High School/ GED Address From To Did You Graduate?YesNo College Degree Address From To Did You Graduate?YesNo REFERENCES Please List Three Professional references: Full Name* Relationship* Company* Phone* Full Name* Relationship* Company* Phone* Full Name* Relationship* Company* Phone* PREVIOUS EMPLOYMENT : Company* Phone* Address* Supervisor* Job Title* Starting Salary $* Ending Salary $* Responsibility* If Other Than Honorable* From* To* Reason For Leaving* May we contact your previous supervisor for a reference?* Company* Phone* Address* Supervisor* Job Title* Starting Salary $* Ending Salary $* Responsibility* If Other Than ,Explain* From* To* Reason For Leaving* May we contact your previous supervisor for a reference?* Company Phone Address Supervisor Job Title Starting Salary $ Ending Salary $ Responsibility If Other Than Honorable,Explain From To Reason For Leaving May we contact your previous supervisor for a reference? MILITARY SERVICE Branch From To Rank At Discharge Type Of Discharge If Other Than Honorable,Explain 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. Signature* Date* IF YOU ARE UNABLE TO WORK A TIME SLOT, PLEASE PUT A 0 IN THE SPACE. **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: Monday *A.M *P.M Tuesday *A.M *P.M Wednesday *A.M *P.M Thursday *A.M *P.M Friday *A.M *P.M Saturday *A.M *P.M Sunday *A.M *P.M Check yes or no: I am able and willing to work a split shift *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 Signature *: Date :* 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 Applicant's Signature *: Date:*: PROFESSIONAL CLEANING & MAINTENANCE SERVICES, LLC BACKGROUND INVESTIGATION AUTHORIZATION FOR PERMISSIBLE EMPLOYMENT/TENANCY PURPOSES I, , understand that in connection with the application process, will request that Global Data Fusion, LLC, conduct a background check (consumer report) on me. I AUTHORIZE THE COMPANY , ITS EMPLOYEES, REPRESENTATIVES AND AGENTS TO INVESTIGATE MY BACKGROUND AND TO OBTAIN A CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT FOR EMPLOYMENT/TENANCY PURPOSES. I FURTHER AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY THE COMPANY ITS AGENTS, ITS EMPLOYEES, REPRESENTATIVES AND AGENTS, TO FURNISH INFORMATION REQUIRED IN CONNECTION WITH THE PREPARATION OF A CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT. My signature below indicates I have carefully read and understand this notice and consent to the release of a consumer report to THE COMPANY for employment purposes/tenancy either in connection with my job application, or in connection with any future decisions concerning my employment, promotion, reassignment or retention as an employee. I understand my consent remains in effect indefinitely until it has been revoked in writing. Background / Consumer Report Authorization (FILLED OUT BY PCMS - NOT APPLICANT) Signature Date FOR PERMISSIBLE EMPLOYMENT/TENANCY PURPOSES BACKGROUND INVESTIGATION DISCLOSURE QUESTIONNAIRE Please answer the following questions below, only after the authorization is signed on page 1. hereafter referred to as “The Company”, pre-screens all applicants before hiring. This policy was enacted to ensure a professional working environment for our employees, and for the protection of our customers/clients. APPLICANT NAME: First Name* Middle Name* Last Name* Sex* Race* ALIASES Social Security* The information provided by me will be the basis for the search of public records, which will include, but not be limited to, a search for criminal arrests/convictions, warrants, civil filings, social security number trace, past employment, bankruptcies, department of motor vehicle records, business filings, educational confirmation, articles of incorporation/limited partnership records, and drug test. I indemnify and hold harmless, THE COMPANY, any of its agents, and any person providing the requested information, from any liability and all damages whatsoever, resulting from the acquisition, use, retention, or disclosure of any such information. I will not hold THE COMPANY, or their employees, or agents responsible for errors or inaccuracies in the acquisition or transmittal of information pertaining to the verification of my background. If any adverse decision is made with regard to my application or employment (if any) based entirely or in part on the information contained in the background report, I understand I will be notified as to the basis of that decision and given a copy of the report, as well as a summary of my applicable rights. I have provided complete and truthful information to The COMPANY and fully understand that any misrepresentations or material omissions concerning the information provided will be grounds for denying my application, withdrawing any offer of employment, or immediate discharge. Applicant Initials * REQUESTED BY* Date* (By signing, I authorize that a photocopy or facsimile of this form serves as the original) Δ
