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ServiceOne USA, Inc.
EMPLOYMENT APPLICATION
[ServiceOne USA, Inc.] (the "Company") is an equal opportunity/affirmative action employer. All qualified
applicants will be considered without regard to age, race, color, sex, religion, nation origin, marital status,
ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.
Last Name __________________First ___________________ Initial ____
Other Name(s) Used _________________________
Home Telephone #
( _____)________________________________
Address, City, State, Zip _____________________________
________________________________________________
________________________________________________
Business or Message #
(______)________________________________
Position Applied For ____________________________
Referred By ___________________________________
Salary Desired ______________________________________
Have you ever interviewed with the Company or its affiliates before? • Yes• No
If yes, list date(s), job title(s) & location(s)
Have you ever been employed by the Company or its affiliates before? • Yes• No
If yes, list date(s), job title(s) & location(s)
Do you have any relatives employed by the Company or its affiliates? • Yes• No
If yes, list date(s), job title(s) & location(s)
Are you at least 18 years old?
• Yes• No
If under 18, do you have a work permit? _____________________
EDUCATION
Circle Highest Grade Completed: High School 9 10 11 12
College, Trade or Business 1 2 3 4
Graduate Studies ___________________
School _____________________________
Address _______________________________
Major Studies __________________________________
Degree, Diploma _______________________________________
License or Certificate
High School ________________________________
College/University ____________________________
Vocational, Business, Other _____________________________
List Any Professional Designations, Other Special Knowledge, Skills or Qualifications
____________________________________________________________________
____________________________________________________________________
For Clerical Applicants Only:
Do you type? • Yes • No If yes, WPM:_________________
Computer Skills (Hardware/Software)_______________________________________
____________________________________________________________________
____________________________________________________________________
EMPLOYMENT HISTORY
List all employments for the past 10 years, starting with the most recent position. All information must be
completed. You may attach a resume, but not in place of completing the required information.
Employed From
/ /
Employer Name __________________________
Supervisor Name __________________________
Starting Salary ________________________________
Employed Until
/ /
Employer Address _______________________________
Supervisor Phone # _______________________________
Ending Salary ______________________________
Job Title _____________________________
Reason for Leaving ____________________________
Duties & Responsibilities _______________________________
Employed From
/ /
Employer Name __________________________
Supervisor Name __________________________
Starting Salary ________________________________
Employed Until
/ /
Employer Address _______________________________
Supervisor Phone # _______________________________
Ending Salary ______________________________
Job Title _____________________________
Reason for Leaving ____________________________
Duties & Responsibilities _______________________________
Employed From
/ /
Employer Name __________________________
Supervisor Name __________________________
Starting Salary ________________________________
Employed Until
/ /
Employer Address _______________________________
Supervisor Phone # _______________________________
Ending Salary ______________________________
Job Title _____________________________
Reason for Leaving ____________________________
Duties & Responsibilities _______________________________
GENERAL
Yes No
• • May we contact your current employer for references?
• • If hired, will you be able to work overtime?
• • Will you be able to perform the essential job functions for the position you are applying for with or
without reasonable accommodation?
• • Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which
has not been annulled, expunged or seals by court? (A ?yes? response does not automatically disqualify your
application.)
CERTIFICATION & AUTHORIZATION
The above information is true and correct. I understand that, in the event of my employment by the Company, I
shall be subject to dismissal if any information that I have given in this application is false or misleading or if I
have failed to give any information herein requested, regardless of the time elapsed after discovery.
I authorize the Company to inquire into my educational, professional and past employment history references as
needed to research my qualifications for this position. I hereby give my consent to any former employer to
provide employment-related information about me to the Company and will hold the Company and my former
employer harmless from any claim made on the basis that such information about me was provided or that any
employment decision was made on the basis of such information. I further authorize the Company to obtain any
credit and consumer check.
I understand that nothing in this employment application, the granting of an interview or my subsequent
employment with the Company is intended to create an employment contract between myself and the Company
under which my employment could be terminated only for cause. On the contrary I understand and agree that, if
hired, my employment will be terminable at will and may be terminated by me or the Company at any time and for
any reason. I understand that no person has any authority to enter into any agreement contrary to the foregoing.
If employed, I will be required to provide original documents which verify my identity and right to work in the
United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be
used for completion of Form I-9.
I hereby acknowledge that I have read and agree to the above statements.
Signature __________________________ Date ______________
KCB INFORMATION SERVICES
CRIMINAL BACKGROUND CHECK AUTHORIZATION
I authorize KCB Information Services and ServiceOne USA, Inc. to pull a criminal background
Check on me.
I also authorize KCB Information Services to provide ServiceOne USA, Inc. a copy of this report.
Applicant information:
__________________________________
Name
__________________________________
Address
__________________________________
City, State Zip
__________________________________
Social Security Number
__________________________________
Date of Birth
__________________________________ ______________
Signature Date
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