Employment Application | BHI Services LLC

1

Position Information

Position Applied For * Required.

Date Available * Required.

Desired Pay

Employment Type (check all that apply):

Full-TimePart-TimeTemporarySeasonal

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

Required.

Will you now or in the future require visa sponsorship for employment? *

Required.

2

Personal Information

Full Name (Last, First, Middle): *Required.

Street Address: *Required.

City:

State:

ZIP Code:

Phone (Primary): *Required.

Phone (Secondary):

Email Address: *Enter a valid email.

Are you at least 18 years of age? *

Required.

Have you previously been employed by BHI Services, LLC? *

Required.

If yes, when:

3

Education

Education 1

School Name

City & State

Type (High School / College / Trade / Other)

High SchoolCollegeTradeOther

Years Attended

Did You Graduate?

Degree / Diploma / Certificate

Education 2

School Name

City & State

Type (High School / College / Trade / Other)

High SchoolCollegeTradeOther

Years Attended

Did You Graduate?

Degree / Diploma / Certificate

4

Employment History

List most recent employer first. Attach additional sheets if necessary.

Employer 1

Employer Name *Required.

Job Title *Required.

Supervisor Name

Phone

Address

City

State

ZIP Code

Start Date

End Date

Starting Pay

Ending Pay

Reason For Leaving

May we contact this employer?

Responsibilities

Employer 2

Employer Name

Job Title

Supervisor Name

Phone

Address

City

State

ZIP Code

Start Date

End Date

Starting Pay

Ending Pay

Reason For Leaving

May we contact this employer?

Responsibilities

5

Professional References

Do not list relatives or former supervisors already listed above.

Reference 1

Name

Relationship

Phone

Email

Years Known

Reference 2

Name

Relationship

Phone

Email

Years Known

Reference 3

Name

Relationship

Phone

Email

Years Known

6

Background Information

Do you hold a valid driver's license? *

Required.

Driver's License Number

State Issued

Expiration Date

Have you had any driving violations in the past 3 years?

If yes, please describe:

Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodation? *

Required.

If no, please describe what accommodations would be needed:

7

Applicant Authorization & Signature

I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. I understand that false or misleading information may result in disqualification from consideration or, if employed, termination of employment. I authorize BHI Services, LLC to verify all information provided, including contacting former employers, educational institutions, and references.

I understand that this application is not a contract of employment and that, if hired, my employment will be at-will, meaning either party may terminate the employment relationship at any time, with or without cause or notice, to the extent permitted by law.

I consent to a background check and drug screening as required by BHI Services, LLC as a condition of employment.

Resume (optional · PDF or Word, up to 8 MB)

Choose file No file chosen — you can still apply without one

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Applicant Signature *Required.

Date *

Printed Name *Required.

Position Information

Personal Information

Education

Employment History

Professional References

Background Information

Applicant Authorization & Signature

Application Received!