Application for Employment for Integrated Pest Management

Thank You.

We appreciate your interest in I.P.M. This application form helps us evaluate your qualifications for employment. Please respond accurately and completely to each question. All prospective employees receive consideration without discrimination  of race, creed, color, gender, age, disability, religious belief, sexual orientation, marital status, disability, national origin or any other legally protected status. You are not required to furnish information prohibited by federal, state, or local law.

About You


Job Duty Information

Have you reviewed the Pre-Interview Guide or Job Description for the position you seek?

Yes 
No 


Do you understand the job’s performance and physical requirements?

Yes 
No 

What days would you be available to work? ( Check all that apply )

Monday 
Tuesday 
Wednesday 
Thursday 
Friday 
Saturday 
Sunday 

What time would you be able to start work each day?

5AM 
6AM 
7AM 
8AM 


What time would you have to finish work each day?

4PM 
5PM 
6PM 
7PM 


Are there any days or times when you are regularly not available to work?

Yes 
No 


If yes, describe. (Check One or More)

What type of employment are you looking for?

Full-time 
Part-time 
Temporary 
Seasonal 


Are you a US citizen?

Yes 
No 


If no, can you demonstrate legal authorization to work in the US?

Yes 
No 


If under 18 years of age, do you have a work permit?

Yes 
No 


Have you ever been employed here?

Yes 
No 


If yes, when?


When are you available to start work?

If necessary, are you willing to relocate?

Yes 
No 
Possibly 

If necessary, are you willing to travel overnight?

Yes 
No 

If yes, how often?

If part of job’s requirements, do you have a valid driver’s license?

Yes 
No 

If yes, License Number


Have you used names or social security numbers other than those on this application?

Yes 
No 

If yes, please list:

Do you have any physical limitations that would limit your job performance?

Yes 
No 

If yes, please list:

Work Experience (Please start with your most recent position first.)

Education

Elementary School 
High School 
Technical College 
University 
Graduate School 

High School

College/Graduate School

Military Experience (if applicable)

Other

References (include only people familiar with your work experience—do not list relatives)