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Employment Application

EMPLOYMENT APPLICATION

Complete the below form and check the appropriate agreement box signifying the information you provided is accurate and you authorize Premier Maintenance, Inc. to investigate and inquire on your employment, education or any other matters as necessary for an employment decision.

Premier Maintenance, Inc.

819 Tucker Court, Winder, GA 30680

Employment Application

Full Name

Date

Street Address

City

State

Zip

Mobile Phone

Alt Phone

E-Mail

Date of Birth

Social Security Nr.

Position Applying For?

Date Available

Desired Salary

Are you a Citizen of the US?

Yes

No

If No, Are You Authorized to Work in the U.S.?

YES

NO

SECTION SEPERATOR

CRIMINAL RECORD SECTION

CRIMINAL RECORD

We Require Background Checks - Have you ever been convicted of a Crime?

YES

NO

If Yes, Give Dates and Explain.

SECTION SEPERATOR

DRIVING RECORD SECTION

DRIVING RECORD

Do you have a GA Drivers License?

YES

NO

Do you have a CDL License?

YES

NO

Drivers License Nr.

Experation Date

Have you had any moving violations in the past three years?

YES

NO

If Yes, How Many?

Have you been involved in any accidents in the past three years?

YES

NO

If Yes, when?

EDUCATION - SECTION

EDUCATION

High School.

Did you Graduate?

YES

NO

If no, do you have a GED?

YES

NO

Years completed?

College/University

Did you graduate?

YES

NO

Nr of years completed

Major

Degree

Do you have any other special skills, certificates, or qualifications

YES

NO

If yes, please explain

SECTION SEPERATOR

REFERENCES SECTION

REFERENCES : Please provide names, telephone numbers and relationships of 3 references whom are not related to you.

Name

Phone Nr.

Relationship

Years Known

Name

Phone Nr.

Relationship

Years Known

Name

Phone Nr.

Relationship

Years Known

SECTION SEPERATOR

PREVIOUS EMPLOYMENT SECTION

PREVIOUS EMPLOYMENT

(BEGIN WITH MOST RECENT)

Free Text

Dates of Employment: (From - To)

From

To

Position

Responsibilities

Name of Employer

Phone

Supervisor

Reason for Leaving

Annual Salary

Starting Position

Annual Salary

Ending Position

May we contact this employer for a reference?

YES

NO

If not, please explain why

SECTION SEPERATOR

PREVIOUS EMPLOYMENT - CONT.

PREVIOUS EMPLOYMENT - CONT.

Dates of Employment: (From - To)

Dates of Employment: (From - To)

From

To

Position

Responsibilities

Name of Employer

Phone

Supervisor

Reason for Leaving

Annual Salary

Starting Position

Annual Salary

Ending Position

May we contact this employer for a reference?

YES

NO

If not, please explain why

SECTION SEPERATOR

PREVIOUS EMPLOYMENT - CONT.

PREVIOUS EMPLOYMENT - CONT.

Dates of Employment: (From - To)

Dates of Employment: (From - To)

From

To

Position

Responsibilities

Name of Employer

Phone

Supervisor

Reason for Leaving

Annual Salary

Starting Position

Annual Salary

Ending Position

May we contact this employer for a reference?

YES

NO

If not, please explain why

SECTION SEPERATOR

Opt-In

By checking this box, I certify that my answers are true and complete to the best of my knowledge. I authorize you to make

investigations and inquires of my personal, employment, education or any other related matters as may be necessary for an employment decision.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Full Name:

Thank you for contacting us.
We will get back to you as soon as possible.

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819 Tucker Court
Winder, GA 30680

OFFICE HOURS

Mon - Fri: 8:00 am - 5:00 pm
Sat - Sun: Closed

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