Application for Employment

PLEASE PRINT APPLICATION AND MAIL IT TO:

My Handyman of Lower Bucks County
211 North Sycamore St.
Newtown, PA 18940

Phone: 215-497-1040

Application for Employment

This application form helps the company to evaluate your suitability for employment. It is not an employment contract. Please answer each question completely and to the best of your ability. False or misleading statements and/or material omissions are grounds for refusal, or termination, of employment and benefits. Federal law provides penalties for false statements or documents related to U.S. employment eligibility.

We consider all applicants for employment without discrimination because of gender, marital status, race, age, creed, or national origin, or other legally protected status. Additional testing of job related skills necessary to accomplish the responsibilities for the position for which you are applying may be required prior to your employment.

Section 1 - Personal Information

Name (last, first, middle) ______________________________________________________

Present address (city, state, zip code) _____________________________________________

______________________________

No. years there ____________

Previous address (city, state, zip code) ____________________________________________

_____________________________

No. years there _______

Social Security Number ____________________

Home telephone Work telephone _______________________

OK to call at work? Y N

Please provide any special information we may need about your name, or use of another name, for us to be able to check your work record and otherwise verify the information given in this Application.

Are you employed? Y N On what date would you be available for work?

Goals (What would you like to be doing in 2 years?)

In case of an emergency, we should notify: Name__________________ Phone __________________________

Section 2 - Employment Interest

Position desired If hired, can you provide the documents required to prove that you are legally able to work in the U.S.? Y N

Can you perform the essential job functions for the position for which you are applying? Y N

Can you work 8 am - 5 pm, Monday through Friday? Y N

List special skills, training, experience which might help you while working for My Handyman :

What is the most important to you? Place a 1 by the most important, 2 by the next, and so forth.

___ Health Benefits

___ Free weekends and evenings

___ Income

___ Paid vacation

___ Advancement

Section 3 - Background Information

Have you ever been convicted of a felony offense? Y N

Have you ever been convicted of a misdemeanor offense? Y N

Do you have any pending misdemeanor or felony offenses? Y N

Have you ever been convicted of a driving offense? Y N When:

Drivers License # State Expiration

Restrictions

Have you ever threatened or committed an act of violence, harassment or discrimination against a fellow employee, customer, or any other person? Y N

If you answered yes to any of the above, please explain.

Section 4 - Education

Name/location of the school most recently attended_________________________________

Last grade completed Are you currently attending school? Y N

If yes, night classes day classes _________________________Where are the classes?

__________________________________________________________________

Are there any classes or work experiences that might help you at My Handyman ?

Section 5 - Personal References

List two people who know you and who are not relatives.

Name____________________________How long have they known you? ______________

How do you know them? __________________________________

Address _______________________________________________

Telephone _____________________________________________

Name____________________________How long have they known you? ______________

How do you know them? __________________________________

Address _______________________________________________

Telephone _____________________________________________

Section 6 - Employment Record

Have you been discharged or asked to resign by any previous employer? Y N

If yes, please describe why

Please list information about your last two jobs:

Employer's Name______________________ Type of Business__________________________

Complete Address _____________________________________________________________

Job Title_________________________ Employed From_______________ to_______________

Duties___________________________Immediate Supervisor____________________________

Telephone___________________ Reason for Leaving__________________________________

Employer's Name______________________ Type of Business__________________________

Complete Address______________________________________________________________

Job Title_________________________ Employed From_______________ to______________

Duties___________________________Immediate Supervisor___________________________

Telephone___________________ Reason for Leaving_________________________________

May we contact the employers listed above? Y N If not, please indicate which one(s) you do not wish us to contact:

Section 7 - Authorization and Understanding Certification

(Please initial in the box to the left of each statement)

• I certify that the answers given by me to the questions contained in this application, and statements made by me, are complete and true to the best of my knowledge and belief. I understand that any false information, material omissions or misrepresentations of facts requested in this application may result in rejection of my application or termination at any time during my employment.

I certify that I am not a current user of illegal drugs.

I understand and acknowledge that, as a condition of my being offered employment and continued employment, I will submit upon request to such lawful examinations as may exist to test for the illegal use of drugs.

I understand that I may not work under the influence of alcohol, drugs, chemicals, or other controlled substances. I also understand that I may be required to submit to examinations that test for such substances if I am involved in a work-related accident.

I agree to sign, as a requirement of employment, a Release and Authorization Agreement and other documents necessary to obtain consumer credit reports. I understand that these documents authorize the company and/or any of its agents, at any time before and during my employment, to conduct reference checks, driving and criminal history checks and other consumer report investigation(s) considered necessary.

I understand that all offers of employment require satisfactory proof of my identity and legal authority to work in the United States. I also understand that an offer of employment is conditioned upon the company's receipt of satisfactory responses to reference requests and background checks.

If I am offered employment, I understand that I will be asked to complete a medical history questionnaire and/or other medical examination.

I understand and agree that if offered employment by the company, and I accept the offer, I will become an "at-will" employee of the company. As an "at will" employee, I will have the right to terminate my employment at any time for any reason, or for no reason, with or without advance notice. I further understand and agree that the company has the same right to terminate my employment, with or without cause and with or without advance notice. I also understand that, if employed, my "at-will" employment status does not change unless the company president/owner, and I, sign a written document that changes my employment status.

I understand and agree that employee handbooks, manuals, personnel policies, and procedures are not employment contracts and do not change my status as an "at-will" employee.

PLEASE READ

This application will only be considered for the ninety-day period after its receipt by My Handyman . Should you wish to be considered after the expiration of this period, you must reapply.

Applicant signature: Date:

Interviewed by: Date:

The rules and standards for employment related documents are constantly changing and are subject to federal, state, and local laws and regulations. You are advised to consult competent labor attorneys when evaluating and/or implementing employment related documents.