Apply to PDQ

First Name *

Middle Name

Last Name

Address *

City *

State *

Zip *

Phone *

Position(s) Applying For:

Application Date (mm/dd/yyyy)

How did you hear about us?

Expected Wage

Have you ever filed an application with us before?

If yes, give date (mm/dd/yyyy):

Have you ever been employed by PDQ Tower Services, Inc. before?

If yes, give date (mm/dd/yyyy):

On what date would you be available for work? (mm/dd/yyyy)

Are you currently on lay-off status and subject to recall?

Are you currently employed?

May we contact your present employer?

If you are less than 18 years of age, can you provide required proof of your eligibility to work?

Are you prevented from lawfully becoming employed in this country because of visa or Immigration Status? Proof of citizenship or immigration status will be required upon employment.

Can you travel if a job requires it?

Are you available to work weekends?

Have you been convicted of a felony within the last seven (7) years? Conviction will not necessarily disqualify an applicant from employment.

If Yes, please explain:

How many years experience do you have in the area for which you are applying? (Years/Months)

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

High School

Course of Study

Years Completed

Diploma/Degree

Undergrad College

Course of Study

Years Completed

Diploma/Degree

Graduate/Professional

Course of Study

Years Completed

Diploma/Degree

Other

Course of Study

Years Completed

Diploma/Degree

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer

Address

Phone

Job Title

Supervisor

Reason for Leaving

Start Date

End Date

Starting Pay

Ending Pay

State any additional information you feel may be helpful to us in considering your application.

Professional References

Name

Phone

Title

Organization

Name

Phone

Title

Organization

Name

Phone

Title

Organization

Please read the following statements carefully before signing this application.

I affirm that all statements I have made on this application or on my resume are true and correct to the best of my knowledge. I understand that any false statement or misrepresentation on this application will be just cause for refusal to hire or for my immediate termination at any time during my employment.

I understand and agree that if employed by PDQ Tower Services, Inc., I will regard, preserve and protect all confidential and proprietary information and material. I further understand that I, or this company may terminate my employment at any time, with or without cause.

I understand and agree that I may be required to take a physical examination and drug test as a condition of hiring or continued employment. I agree to consent to such tests at such time as designated by the company and to release the company, its directors, officers, agents or employees from any claim arising in connection with the use of such tests.

I understand that neither this document nor any offer of employment from PDQ Tower Services, Inc., constitutes an employment contract, unless a specific document is executed by an authorized representative of PDQ Tower Services, Inc. to that effect. I have read and understand the foregoing statements and accept same as conditions of my employment.

Applicant's Full Name

Date

I hereby authorize PDQ Tower Services, Inc. (employer) permission to obtain a copy of my driving record.

Employee Name

Driver's License Number

State Issued

Date of Birth

Today's Date