Job Application Please fill in this form and submit when completed. Starred* items are required. Prewitt Online Job Application Date * Date of Birth * First Name * Last Name * Address * Address II (optional) City * State * Zip * Daytime Phone (a number we can call during business hours) Evening Phone Alternative Phone (such as a mobile #) Are you at least 21 Years of age? * Yes No Do you have a valid Drver's License? * Yes No Do you have your own transportation to/from job sites? * Yes No Have you ever served in the U.S. Armed Forces? Yes No Branch of Service: Date available to start Position(s) Applying for Supervisor OtherOther Employment Desired * Part-time (1-2 hours)Part-time (3-4 hours)Part-time (5 or more hours)Full Time (40 hours/week) Availability Daytime? Evening? Night? (check all that apply) Time available to start cleaning each night? Desired hourly wage: How did you hear about us? Any relatives employed with us? (if so, Who?) Have you ever been employed with us before? * Yes No If Yes, When? Have you ever filled out an application before? * Yes No If Yes, When? Do you have a problem being on your feet for 3 hours at a time? If Yes, explain: * No YesYes Do you have any physical restrictions with repetitive motions such as continual bending/stooping? * No YesYes Have you ever been convicted of a felony? * Yes No If YES, Explain: Most Recent or Current Work Experience Employer Date Started Date Ended Schedule/hours Employer's Address Employer's Phone Number Hourly Rate/Salary Job Title Job Duties Supervisor's Name/Title May we contact him/her? Yes No Reason for leaving Additional Information Any other additional comments that you feel would be important in our consideration of your application: "By signing below and/or submitting this form via eMail or the Prewitt website, I certify that the information given in this application is true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application for employment shall be grounds for immediate dismissal. I authorize the investigation of all statements contained herein and the references and employers listed above to release to Prewitt Contract Services, Inc. any and all information concerning my previous employment and/or any pertinent information they may have, personal or otherwise, to release Prewitt Contract Services, Inc. from any and all liability for any damage that may result from utilization of such information. I understand that Prewitt Contract Services, Inc.is an "at will" employer. No representative of Prewitt Contract Services, Inc. has any authority to go into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless In writing and signed by an authorized company representative. I give permission to Prewitt Contract Services, Inc. to perform criminal background checks. I give permission to agree that Prewitt Contract Services, Inc. to perform a drug screen by means they feel necessary and agree to submit to a specimen upon request. I understand and I may be subject to random drug screening if employed." I agree to the terms above * I Agree Today's Date * Δ
