Online Application

Date

Personal Information

Last Name
First Name		Middle Initial
Present Address - Street/Apt#
City	State Zip
Phone (main)		Message/Cell Phone
Email
Are you 18 years of age or older?	YES NO
**The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years old.

Are you legally eligible to work in the United States? (DMBurr will require verification of this upon hire)

Yes  No

Position(s) Applying For: (Check all that Apply)

Custodial Floor Care Window Cleaning Supervision Managment Administration

Check Locations Available in: (Check all that Apply)

Flint Lansing Livonia Farmington Hills Romeo Washington Twp Sterling Heights

Detroit Saginaw Niles Dowagiac Mio Baldwin Reese Grand Blanc Burton

Northern Indiana Atlanta, GA Other

How did you hear about us? Please Select One Employee Referral Word of Mouth News Paper Internet BillBoard Yellow Pages

Check the days you are available to work:

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Please select one:  Part Time Full Time Call In (As Needed)

Maximum numbers of hours per shift

Shift(s) you can work

First Shift: 7-3pm Second Shift: 3-11 pm Third Shift: 11-7am

Hours of availability to work?
When would you be able to start?
What is your desired starting wage?
Have you ever been employed by DMBurr Services?	Yes    No
If yes, When and Where did you work for us?
What name did you use when employed by DMBurr Services?
What was your reason for leaving?

Do you have experience with any of the following?

Window Cleaning Floor Care Carpet Cleaning Supervision Inspecting Training

If so, Please Explain in Detail 

Have you ever been convicted of a felony or misdemeanor?	Yes    No
Describe
Are there any criminal charges currently pending? (Please note, prior criminal convictions do not necessarily mean you will not be hired)	Yes No

Education Background

	Name/Location of School	Number of Years Attended	Did you Graduate?	Subjects Studied
Grammar School			Y N
High School			Y N
College			Y N

Employment History

(Please start with the most recent or current employer)

Employer 1
Address
City	State Zip
Telephone Number
Name of Supervisor
Position
May we contact this employer?	Yes    No
Beginning Date	End Date
Reason for Leaving?
Wage

 

Employer 2
Address
City	State Zip
Telephone Number
Name of Supervisor
Position
May we contact this employer?	Yes    No
Beginning Date	End Date
Reason for Leaving?
Wage

 

Employer 3
Address
City	State Zip
Telephone Number
Name of Supervisor
Position
May we contact this employer?	Yes    No
Beginning Date	End Date
Reason for Leaving?
Wage

Physical Record

Do you have any physical limitations that preclude you from performing any work for which you are being considered? Yes No

If yes, what can be done to accomodate your limitation? Please describe:

References

Name	Address	Phone	Years Known

The following boxes must be checked before this form will be submitted.

By Submitting this application, I attest that all information is accurate and complete to the best of my knowledge. I understand that this information will be kept confidential and used only for employment purposes with Building Services. I understand that falsification of information will result in rejection of this application or termination after hire.

I certify that the facts contained in this application are true to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references listed above to give you personal or otherwise, and release all parties from liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period, and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.