Home Services Shop Employment Application

78 Washington Avenue • Pleasantville NY 10570 • 914-769-1100
39 Main Street • Mt. Kisco, NY 10549 •  914-244-6666

The Home Services Shop, LLC (the “Company”) is an equal opportunity/affirmative action employer. All qualified applicants will be considered without regard to age, race, color, sex, religion, nationality, marital status, ancestry, citizenship, veteran status, sexual orientation or preference, or physical or mental disability.

 
Personal Information
Last Name First Mi   Social Security Number
 
Address  State   Zip Code
 
City    Home Phone
   
E-mail Address    Cell Phone
   
Position Applied For:    Referred By:
   
Are you at least 18 years old?
Yes  No		 If under 18, do you have a work permit?
 Yes  No  Not Applicable
Have you interviewed with this company previously?
 Yes  No		 Have you ever been employed by this company previously? Yes  No
Do you have any relatives employed by this company?
Yes  No		 If so, please list:
Please rate your skill level for the following: Please indicate if you own the following tools and rate your experience level:
Carpentry:    Masonry:  
Electrical:    Electronics:  
Painting:    Plaster/Sheetrock:  
Wallpapering:    Furniture Repair:  
Computer:    Grout/Caulk:  
Power Washing:    Tiling:  
Plumbing:        
   Own Experience
  Cordless Drill:  Yes  No
  Electrical:  Yes  No
  Painting:  Yes  No
  Wallpapering:  Yes  No
  Computer:  Yes  No
  Power Washing:  Yes  No
  Plumbing:  Yes  No
Do you have your own transportation?        Yes  No    Salary Requirement:  
If Yes, please specify type of vehicle:      Hourly:                                     $ 
Is this vehicle available for work?     Yes  No    Or Annual:                                $
Please provide an emergency contact:     Start Date: (mm/dd/yyyy)
What is the earliest date you can start?    
   
ARE YOU A U.S. CITIZEN OR AN ALIEN LEGALLY AUTHORIZED TO WORK IN THE UNITED STATES? (If hired you must be able to submit verification of your identity and legal right to work in the United States)   Yes  No
 
Specify all Days/Hours Available:
  Any Day/Any Hour      Applying for: Full Time Part Time
Monday Tuesday Wednesday
Thursday   Friday Saturday
 
Education Information
Please Indicate Highest Grade Completed:
 
High School 9th grade 10th grade 11th grade 12th grade Did not complete High School
College, Trade or Business 1 years 2 years 3 years 4 years Did not attend
Graduate Studies   Yes
School Address Major Studies Degree, Diploma,
License or Certificate
Name of School:
College/University:
Vocational, Business, Other:
 
List Any Professional Designations:

Other Special Knowledge, Skills or Qualifications:
 
For Clerical Applicants Only 
Please Rate Your Computer Skills:
General Computer Skills:
Internet Experience:
Microsoft Word:
Microsoft Excel:
Other Computer Skills:
 
Employment History
 
Employed From:
Employer Name:
 		Supervisor Name:
Starting Salary:
Employed Until:
 		 Employer Address:
 		 Supervisor Phone:
 		Ending Salary:
 
Job title: Reason for Leaving:
Duties and Responsibilities:

Employed From:
Employer Name:
 		Supervisor Name:
Starting Salary:
Employed Until:
 		 Employer Address:
 		 Supervisor Phone:
 		Ending Salary:
 
Job title: Reason for Leaving:
Duties and Responsibilities:

Employed From:
Employer Name:
 		Supervisor Name:
Starting Salary:
Employed Until:
 		 Employer Address:
 		 Supervisor Phone:
 		Ending Salary:
 
Job title: Reason for Leaving:
Duties and Responsibilities:

Employed From:
Employer Name:
 		Supervisor Name:
Starting Salary:
Employed Until:
 		 Employer Address:
 		 Supervisor Phone:
 		Ending Salary:
 
Job title: Reason for Leaving:
Duties and Responsibilities:

General Information 
May we contact your current employer for references? Yes  No
If hired, will you be able to work overtime? Yes  No
Have you ever been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by the court? Yes  No
At this time are there any criminal charges pending against you? Yes  No
(A yes response to either of the above two questions does not automatically disqualify your application. To help us evaluate you’re application, please describe the nature of the crime (s), when they occurred and your subsequent rehabilitation.)
 
Certification and Authorization 
The above information is true and correct. I understand that, in the event of my employment by The Home Services Shop, 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 Home Services Shop to inquire into my educational, professional and past employment history references as needed to research my qualifications for the position. I hereby give my consent to any former employer to provide employment-related information about me to The Home Services Shop and will hold The Home Services Shop 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 Home Services Shop to obtain any credit and consumer check.

I understand that an offer of employment is conditional to a satisfactory drug test (urine sample). Further, I understand the Home Services Shop may ask me for a urine sample at any time during my employment.

I understand that nothing in this employment application, the granting of an interview or my subsequent employment with The Home Services Shop is intended to create an employment contract between myself and The Home Services Shop 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 Home Services Shop 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.   Yes  No            Date: