Employment Application - PMB Services, Inc.

Comments

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An Equal Opportunity Employer - All qualified applicants will receive consideration for employment without regard to race, creed, color, religion, sex, national origin, age, genetic information, military status, or any other legally protected status.

PERSONAL INFORMATION

Incomplete information could disqualify you from further consideration. Please complete all fields.

Name*

First Last

Today's Date*

Address*

Street Address Address Line 2 City State ZIP Code

Email Address*

Phone Number

Additional Phone Number (optional)

Are you eligible to work in the United States?*

Yes

Are you at least 18 years or older?*

(If no, you may be required to provide authorization to work.)

Yes

Have you ever been terminated from employment or asked to resign by an employer?*

Yes

If yes, please provide company names and details.*

Can you work any shift?*

Yes

Can you work overtime, including weekends?*

Yes

Are you able to perform the essential functions of the job for which you are applying?*

Yes

EMPLOYMENT DESIRED

Available Start Date*

Hourly Rate/Salary Desired*

Position Desired*

Are you currently employed?*

Yes

If yes, may we inquire of your present employer?*

Yes

REFERRAL SOURCE

How did you hear about us?*

Walk-In

Referral

Other

Have you ever worked for this company before?*

Yes

If yes, please explain*

Do you know anyone who works for our company?*

Yes

If yes, who?*

EDUCATION

Education

Type of Education	Name and location of school	No. of yrs. Attended	Degree Received	Subjects studied/Major	Actions

There are no Entries.

EMPLOYMENT HISTORY

Include your last seven (7) years of employment history, including periods of unemployment, starting with the most recent and working backwards in time. Incomplete information could disqualify you from further consideration.

Employment History

Date from	Date to	Employer	Job Title	Actions

There are no Entries.

Do you have any special skills, experience and/or training that would enhance your ability to perform the position applied for?*

Yes

If yes, explain*

Computer Skills (please describe)*

REFERENCES

Give the names of three persons not related to you, whom you have known at least three (3) years.

Reference List*

Name

Address, Phone, Email

Company

Years Acquainted

SIGN & SUBMIT

Please read carefully before signing

PMB Services, Inc. is an equal opportunity employer. PMB Services, Inc. does not discriminate in employment on account of race, creed, color, religion, sex, national origin, age, genetic information, military status, or any other legally protected status.

I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for PMB Services, Inc. to hire me. If I am hired, I understand that either PMB Services, Inc. or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative of PMB Services, Inc. has the authority to make any assurance to the contrary.

I attest with my signature below that I have given to PMB Services, Inc. true and complete information on this application. No requested information has been concealed. I authorize PMB Services, Inc. to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal.

Signature*

By checking this box and clicking SUBMIT, you are applying for employment with PMB Services, Inc. You agree that you have completed the on-line application on your own behalf and the information provided herein is accurate and may be verified by our company Human Resources Administrator.

I agree

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Date

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