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    First Name
    M.I
    Last Name


    Address
    City
    Zip
    Phone


    In Case of Accident Nofity-Name
    Relationship


    Address
    City
    Zip
    Phone


    MaleFemaleSingleMarriedDivorcedNumber of Dependents


    Height
    Weight
    Age
    Color of Hair
    Color of Eyes


    Place of Birth


    Owner of a Car?
    If so, state Make
    Year
    Type of Licence


    Have you ever been officially charged with a crime (except traffic violations)?

    If So What


    Have you ever been convicted of a crime (except traffic violations)?

    If So What


    Have you ever been a member of a Building Service Union?

    When


    Presently Employed?Place of Employment


    Present Working Hours - FromToPosition Held


    Length of time in CaliforniaWhere from previously

    Work Experience

    1.From
    To
    Name and Address of Employer


    Position
    Hourly Rate
    Reason for Leaving

    2.From
    To
    Name and Address of Employer


    Position
    Hourly Rate
    Reason for Leaving

    3.From
    To
    Name and Address of Employer


    Position
    Hourly Rate
    Reason for Leaving

    4.From
    To
    Name and Address of Employer


    Position
    Hourly Rate
    Reason for Leaving

    5.From
    To
    Name and Address of Employer


    Position
    Hourly Rate
    Reason for Leaving

    Personal References
    List three persons (not related to you) whom you have known for three years whom we can refer as to your character and habits

    1.Name
    Address
    Occupation

    2.Name
    Address
    Occupation

    3.Name
    Address
    Occupation


    Email Address

    I certify that all of the above statements are true and correct. I hereby authorize Guarantee Pest Control and/or bonding representatives to make any investigations necessary to confirm these statements.

    Bold = Required Field