* Required Field

Position(s) Applied for * :

Name (Last, First, Middle) * :

Maiden Last Name:

Address * :

City * : State * : Zip * :

Telephone * :

Social Security #:

Email Address * :

Type of employment desired : Full Time Part Time Either

Please select the appropriate box.

If you are under 18, can you furnish a work permit? Yes No

Have you ever been employed by Servicemaster Southwest? Yes No

Are you legally eligible for employment in this country? Yes No
(Proof of U.S. citizenship or immigration status will be required upon employment.)

Are you able to meet the attendance requirements of the position? Yes No

Have you ever been CONVICTED of a felony or dishonest act? Yes No
(Such conviction may be relevant if job related, but does not bar you from employment.) If YES, please explain.

Being insured by this company's auto insurance carrier is a condition of employment. Please list any tickets or wrecks within the last year.

Notice to applicants: Screening tests for illegal drug use, as well as background checks, are required as a condition of employment.

From To

Employer

Address



Phone

Supervisor

Nature of work performed & job responsibilities

Reason for leaving

From To

Employer

Address



Phone

Supervisor

Nature of work performed & job responsibilities

Reason for leaving

From To

Employer

Address



Phone

Supervisor

Nature of work performed & job responsibilities

Reason for leaving

From To

Employer

Address



Phone

Supervisor

Nature of work performed & job responsibilities

Reason for leaving

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with ServiceMaster SouthWest.

I, the Applicant whose signature is affixed hereto, and above listed company, hereafter referred as SMSW, for itself and its officers, directors, agents, and employees, mutually agree and contract that any and all claims, disputes, or controversies, whether based on the Constitution, Statutes, Code(s), Ordinances, Rules, Orders, Regulations, and/or common law of the United States or of any state, and or all subdivisions of either, and/or asserted on the basis of contract, quasi-contract, personal injury, tort, offenses, quasi-offenses, or otherwise, or arising out of, in any way relating to this application for employment, or any other application for employment that I may have previously submitted, or may submit in the future, or the Company's decision to hire or not hire me; including the arbitrability of any claim, dispute or controversy, shall be exclusively settled by binding arbitration conducted under the Arbitration Rules of, and before an Arbitration Tribunal of the National Association for Dispute Resolution, Inc., pursuant to the provisions of the Federal Arbitration Act and/or the Texas contrary, including any right to trial by jury, being hereby expressly waived. The Arbitration Tribunal shall be the sole and exclusive determiner of its jurisdiction. Judgment upon any Award may be entered in court having jurisdiction.

I hereby certify that all of the information and statements made or furnished on this application are true and correct and I hereby grant SMSW permission to verify such information and statements. I understand that any false statements or omission on this application may be considered as sufficient cause for rejection of this application, or for dismissal, if such false statement or omission is discovered subsequent to my employment. I further understand that SMSW may perform a pre-employment investigation to determine my suitability for employment and I authorize SMSW to have access to any and all records concerning my education or employment background. I hereby authorize any person or Entity having such information to release same to SMSW. I understand that the pre-employment investigation may include contacting my previous employers, and I hereby authorize such previous employers to release any and all information relating to my employment to SMSW. No supervisor or person other than the President of SMSW can change or otherwise modify any employment agreement. SMSW reserves the right to unilaterally abolish or modify any personnel policy without prior notice. I understand this application will be considered valid and current for a period of not more than thirty (30) days.

ACCEPTED AND AGREED TO:
By typing your name below and submitting this application, you agree to the terms stated above.

Printed Name: