CORBETT EXTERMINATING

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					CORBETT EXTERMINATING
Employment Application
   Please note you must have a minimum 6 year driving history and bring a DMV driver abstract if called for interview

APPLICANT INFORMATION
Last Name                                                   First                                   M.I.          Date

Street Address                                                                                      Apartment/Unit #

City                                                        State                                   ZIP

                                                            Home AND Cell
E-Mail
                                                            Phone Numbers:
Date Available                                 Social Security No.                             Desired Salary

Position Applied for

Are you a citizen of the United States?       YES        NO          If no, are you authorized to work in the U.S.?   YES        NO

Have you ever worked for this company?        YES        NO          If so, when?

Have you ever been arrested or convicted
                                              YES        NO          If yes, explain
of a felony?
Do you have a valid Driver’s License?         YES        NO          If no, explain

In the past (5) Years has your driver’s
                                              YES        NO          If yes, explain
license been suspended or revoked?
Do you currently have any points on your
                                              YES        NO          If yes, explain
license? How many? What violations?
Are you paying driving surcharges?
                                              YES        NO          If yes, explain
Amount? Payment arrangements?


EDUCATION
High School                                              Address

From                   To            Did you graduate?   YES         NO          Degree

College                                                  Address

From                   To            Did you graduate?   YES         NO          Degree

Other                                                    Address

From                   To            Did you graduate?   YES         NO          Degree

Please List any Pest Control Licenses or Training you hold, and any other Experience or Training relevant to your desired job:




REFERENCES
Please list three professional references.

Full Name                                                                   Relationship

Company                                                                     Phone      (      )

Address
Full Name                                                                       Relationship

Company                                                                         Phone    (       )

Address

Full Name                                                                       Relationship

Company                                                                         Phone    (       )

Address




PREVIOUS EMPLOYMENT

Company                                                                         Phone        (       )

Address                                                                         Supervisor

Job Title                                                  Starting Salary      $                        Ending Salary   $

Responsibilities &
Hours

From                 To               Reason for Leaving

May we contact your previous supervisor for a reference?         YES            NO

Company                                                                         Phone        (   )

Address                                                                         Supervisor

Job Title                                                  Starting Salary      $                        Ending Salary   $

Responsibilities

From                 To               Reason for Leaving

May we contact your previous supervisor for a reference?         YES            NO

Company                                                                         Phone        (   )

Address                                                                         Supervisor

Job Title                                                  Starting Salary      $                        Ending Salary   $

Responsibilities

From                 To               Reason for Leaving

May we contact your previous supervisor for a reference?         YES            NO

Have you ever been involved in litigations
                                             YES           NO          If yes, explain
or a worker’s compensation claim?
Do you have employment opportunities
                                             YES           NO          If yes, explain
pending with any other company?
How would you get to and from work?          CAR           BUS         Other:

Do you have any medical conditions,
                                             YES           NO          If yes, explain
previous back and or neck injuries?
Do you have a non-compete agreement
                                               YES         NO          If yes, explain
with your previous employer?
Are you planning to work a second job for
                                               YES         NO          If yes, explain
additional income?


MILITARY SERVICE

Branch                                                                                       From              To

Rank at Discharge                                                                            Type of Discharge

If other than honorable, explain



SKILLS ASSESSMENT- Please answer the following questions, multiple choice responses may be highlighted.
1. What is fifteen percent of 128 ounces?

2. Nine feet is how many inches?
3. How many fluid ounces of concentrate are needed to prepare 100 gallons of material if we use 2 ounces of concentrate for every 10
gallons of water?
4. We need to treat 35% of 1500 linear feet. How many feet are we NOT treating?

5. 27x13=

6. 258÷18=

7. 867+1,858=

8. 26,743-19,867=

9. A school bus is approaching you on the other side of an undivided highway. It stops, with red lights flashing, you:
      a) Should slow down and pass the bus cautiously
      b) Must come to a complete stop, then proceed slowly until you pass the bus
      c) Must stop and wait until the red lights are no longer flashing or the bus is moving again
      d) Can continue, because the bus is on the other side of the street
10. You probably know the danger of driving fast over water: your car can lose its grip on the road (hydroplane) as the tires float on a thin
film of water instead of maintaining contact with the road. Should hydroplaning occur what must you do to immediately regain steering
control?
      a) Increase speed
      b) Pump the brakes
      c) Depress the brake pedal, hold it down gently
      d) Ease your foot off the accelerator
11. You’re in heavy city traffic making a client call. Suddenly an ambulance pulls up behind you, with lights flashing and siren wailing.
You’re completely boxed in, unable to go forward or pull over to the right. Under these circumstances, is it all right to cross the center line,
into oncoming traffic, to make way for the ambulance?
      a) Yes
      b) No
12. It’s a two lane highway in the country. Somehow, your right wheel drifts off the edge of the road onto the shoulder. What is the first
thing you should do?
      a) Turn the wheel immediately to the left
      b) Hold the wheel firmly and ease off the accelerator
      c) Stop as quickly as possible
      d) Move your left wheels onto the shoulder, then quickly turn back onto the road
13. Even if you can’t read the words on a sign, the color tells you something. Match the colors below with the various road signs:

     1)   Green                                                                a)   General Warnings

     2)   Blue                                                                 b)   Gas, food and lodging

     3)   Orange                                                               c)   Forbids certain actions

     4)   Red                                                                  d)   Exits and directions

     5)   Yellow                                                               e)   Road maintenance
14. You’re driving on a major city street and you approach an intersection with a smaller street. You arrive at the intersection at the same
time as a car on the cross street to your right. The traffic light isn’t working. You should:
     a) Stop and yield the right-of-way to the car on your right
     b) Slow down and proceed through the intersection, since you are on a major street
     c) Slow down, honk your horn, and carefully proceed through the intersection
     d) Stop at the intersection and let ALL cross traffic pass before you proceed
15. Driving on the left lane of a crowded highway, the car on your right suddenly swerves and hits you, forcing your car into the center
guardrail. What should you do?
     a) Slam on the brakes
     b) Maintain your grip on the steering wheel and gradually brake to a stop
     c) Maintain your grip on the steering wheel and move to the right
     d) Turn hard to the right to avoid hitting the guardrail again
16. Which of the factors below is responsible for the greatest number of collisions?
     a)   Mechanical failure of the vehicle
     b)   Driver error
     c)   Poorly maintained roadway
     d)   Inclement weather
17. Which of the following is unsafe when passing a truck on the highway?
     a)   Pulling up as close as possible behind the truck to reduce the passing distance
     b)   Completing your pass as quickly as possible
     c)   After passing, not moving back into your lane until you can see the front of the truck in your rearview mirror
     d)   Allowing extra time and distance when passing a truck with multiple trailers
18. You’re in a line of traffic when someone up ahead makes a panic stop. To avoid rear-ending the car ahead of you, you should:
     a) Allow more space between you and the other cars
     b) Prepare to swerve to the left
     c) Prepare to swerve to the right
     d) Since you can’t see that far ahead, there’s nothing you and do to prevent such an accident
19. Coming back to the warehouse at night from a late stop, a car approaches you quickly from behind. First he speeds up, and then he
slows down, swerving from side to side. What’s the best way to escape a drunk driver?
     a) Stay as far in front of his car as possible
     b) Slow down, trying to keep the car behind you
     c) Make a right turn onto another road
     d) Pull to the right and let the car pass you


Pest Control Service Technicians need to real and understand the information on product labels. The label is the law and the instructions
on the label must be followed. Please answer the following questions based on the label below:


DEMON MAX- LABEL
Active Ingredient: Cypermethrin:1 (±).-cyano-(3-phenoxyphenyl)methyl(±)-cis,trans-3-(2,2dichloroethenyl)- 2, 2-
dimethylcyclopropanecarboxylate*………… 25.3% Other Ingredients: 74.7% Total: 100.0%
EPA Reg. No. 100-1218/ EPA Est. 07098-M0-001/ Product of India/ Formulated in the USA
First Aid: If in eyes, Hold eye open and rinse slowly and gently with water for 15-20 minutes.
Remove contact lenses, if present, after the first 5 minutes, then continue rinsing eye. Call a poison control center or doctor for treatment
advice. If swallowed, Call a poison control center or doctor immediately for treatment advice. Environmental Hazards: This pesticide is
extremely toxic to fish. Use with care when applying in areas adjacent to any body of water.
Structures with Wells/Cisterns inside Foundations:
Treat the soil at the rate of 4 gal. of dilute emulsion per 10 lin. ft./ft. of depth of the trench, or 1 gal. per 1.0 cu. ft. of soil. See Mixing
Directions section of the label. Mix thoroughly into the soil taking care to contain the liquid and prevent runoff or spillage.
Do not use in commercial greenhouses or nurseries. Not for use on plants being grown for sale or other commercial use, or for commercial
Pests Concentration of Active Ingredient Dilution Rate:
Ants, Asian Cockroaches, Box-elder Bugs, Carpenter Ants, Carpenter Bees, Centipedes, Chiggers, Cockroaches
Maintenance and Usage:
Crickets, Earwigs, Elm Leaf Beetle, Firebrats, Fleas, Flies, Ground Beetles, Millipedes, Mosquitoes Pill bugs, Silverfish, Sow bugs
Storage and Disposal:
Do not contaminate water, food or feed by storage or disposal. Open dumping is prohibited. Do not reuse empty container.
Environmental Hazards:
This pesticide is extremely toxic to fish. Use with care when applying in areas adjacent to any body of water. Do not apply directly to water,
or to areas where surface water is present or to intertidal areas below the mean high water mark. Do not apply when weather conditions
favor drift from treated areas. Do not contaminate water when cleaning equipment or disposing of equipment wash water.



1.The active ingredient in this product is called:

2. The EPA Registration number is:
3. Can this product be used for fleas indoors?

4. What should you do if you get this product in your eyes?

5. Should the empty container be rinsed out twice and punctured to be disposed of?

6. Can we use oil to dilute this product?

7. Can we properly use this product around fish?

8. Can this product be used in commercial greenhouses or nurseries?




DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
As an applicant for a position with Corbett Exterminating, my signature below authorizes Corbett, their agents, or representatives to conduct
a background investigation as to my character, history of motor vehicle operations, criminal activities, prior employment or any other
investigations, including drug testing, deemed by Corbett to be necessary and proper as they may relate to the position for which I am
applying.
I understand and accept that Corbett has the absolute right to choose not to tender an offer of employment or terminate employment
based on the results of the items listed above.
I fully understand that my refusal to sign this application and authorization can result in my application for employment being denied or can
result in a termination of pending employment.

Signature                                                                                           Date

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posted:8/11/2011
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