Home Services Provider

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* 1. How did you hear about the position?

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* 2. What is your current job title and company?

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* 3. Full Name:

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* 4. Home Address (Street, City State, Zip):

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* 5. Phone:

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* 6. Email:

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* 7. Upload your Resume

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
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* 8. Are there any employers which we may NOT contact to verify your past employment?

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* 9. Are you able to lift and carry weights up to 50 lbs, such as groceries, laundry baskets, and other items around the home which may need to be moved?

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* 10. Please describe your previous customer service and cooking experience. (200 word limit)

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* 11. What is your best quality that you feel will make a significant impact with MDH Home Services? (200 word limit):

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* 12. (Optional) At MDH home services, we feel that excellent communication is critical to our success. We believe that if you say you're going to do something, not only should you do it, but follow up to make sure the person is thrilled with what you've done.  We also take "having pride in your work" to a whole new level & we always put the customer's needs above our own.  These our our core values which are at the heart of our brand's promise to deliver not only a first class employment experience, but also to allow our clients to gain "peace of mind, through free time". Please tell us if one or more of these values align with your own and why:

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* 13. Please list the name, phone number, and relationship of a character reference (someone who can speak to your character as a person):

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* 14. Please list the name, phone number, and relationship of a business performance reference (someone who can speak to your technical abilities):

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* 15. Are you legally authorized to work in the United States?

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* 16. Are you at least 18 years old? (If no, you may be required to provide authorization to work)

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* 17. Have you been  convicted of a felony or misdemeanor?

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* 18. If yes, briefly describe the nature of the conviction.

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* 19. The MDH Homer Services (“Company”) is committed to a policy of Equal Employment Opportunity and will not discriminate against an applicant or employee on the basis of race, color, religion, creed, national origin or ancestry, sex, age, physical or mental disability, use of a guide or support animal because of blindness, deafness, or physical handicap, veteran or military status, genetic information, sexual orientation, or any other legally recognized protected basis under federal, state, or local law. The information collected by this application is solely to determine suitability for employment, verify identity, and maintain employment statistics on applicants.

Applicants with disabilities may be entitled to reasonable accommodation under the terms of the Americans with Disabilities Act and certain state or local laws. A reasonable accommodation is a change in the way things are normally done which will ensure an equal employment opportunity without imposing undue hardship on the Company. Please inform the company’s personnel representative if you need assistance completing any forms or to otherwise participate in the application process.

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* 20. I understand that I may be subject to a pre-employment drug test after receiving a conditional offer of employment and must receive a negative result for illegal drug use before being permitted to commence work with the Company. (Initials)

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* 21. I understand that I may be subject to a pre-employment medical examination after receiving a conditional offer of employment and must meet the qualifications for the position, with or without reasonable accommodation, before being permitted to commence work with the Company. (initials)

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* 22. I understand that, where permissible under applicable federal, state and local law, I may be subject to a pre employment background check after receiving a conditional offer of employment to investigate my criminal background, driving record (for driving positions), and other matters related to my suitability for employment. I understand that a separate disclosure and consent form will be provided to me prior to any such background check. (Initials)

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* 23. I also understand that a record of criminal conviction or less than honorable discharge from military service will not necessarily bar me from employment, unless consistent with law and if related to legitimate qualifications related to the position. (initials)

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* 24. I authorize the Company and its representatives to contact my prior employers and all others (with the exception of my current employer if I have marked “May we contact?” of this application as “No”) for the purpose of verification of the information I have supplied, and I hereby RELEASE FROM ANY LIABILITY the Company and its representatives related to seeking, gathering, and using such information to make employment decisions (to the extent consistent with law), and all other persons or organizations for providing such information. I authorize employers, schools, and other persons named on this application to provide any relevant information or transcripts requested. (Initials)

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* 25. I hereby certify that, if employed, I will report to my supervisor, a representative of Human Resources, or other member of management, if I am ever harassed by someone in the Company or if I ever become aware of any unethical behavior by any employee. (Initials)

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* 26. I expressly understand and agree that, if employed, my employment, having no specified term, is based upon mutual consent and may be terminated at will, with or without cause, by either party without prior notice to the other, unless otherwise prohibited by law. (Initials)

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* 27. I hereby certify that all of the above information is true and complete, and I understand that any falsification or omission of information may disqualify me from further consideration for employment or, if hired, may result in termination regardless of the time elapsed before discovery. Note: An offer of employment is conditioned upon complying with the Company’s requirements including, but not limited to, signing a separate disclosure and consent form prior to any background investigation.

Please type your full name below acknowleging the above.

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