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Holobinko Employment Application

Position you are applying for.

Have you ever worked for Merry Maids or ServiceMaster? If yes, which office? Who was your supervisor? When? Why did you leave?

Do you have a car that can be used for work purposes?

Do you have automobile insurance? If yes, when does your policy expire?

Do you have a valid driver’s license? Driver’s License #___

Have you ever been refused bond? If yes, explain.

Have you ever been convicted of a felony or other serious offense (other than a minor traffic violation)? If yes, explain.

Please include Name of High Schools/Colleges/Trade Schools, State, Dates Attended, Graduated, Major Study, Credit, Grade, Degree.

List only individuals living within the United States or Canada. Name, Relationship, Address, City, State, Phone.

List only individuals familiar with your work ability. Do not include relatives. Include Name, Relationship, Occupation, Address, Phone, Years known.

Beginning with most recent, list all past employers. Include Name of Company, From (Month / Year), To (Month / Year), Type of Business, Job Title, Telephone, Immediate supervisor, Description of duties, What did you like most? What did you dislike?


I hereby authorize Holobinko Consortium or its designated representative to contact my former employer, schools, or any other information source available to them to gather data on me and my business and education life deemed necessary to act on my application for new employment or continuation of existing employment. The information may be gathered by Holobinko Consortium or any duly authorized investigative reporting or similar type agency. The information may include, but is not limited to military records, employment records, school transcripts and felony conviction records. I willingly and freely release and hold harmless and deny any recourse on my behalf to any person, company, military agency, school or any other individual agency or institution who releases or provides information to Holobinko Consortium or it’s duly authorized representatives.

It is the policy and practice of Holobinko Consortium to recruit, hire, train and promote qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status or other areas covered by federal, state and/or local employment laws and regulations.

I certify that the information contained in the Employment Application is correct the the best of my knowledge and understand that any false information, omissions or misrepresentations of facts given in this application may be grounds for refusal to hire or grounds for termination of employment.