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Please fill out the form below and a Terminix representative will contact you regarding your application. *Name (First and Last): Social Security Number: *Address: *City: *State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip: *Home Phone Work Phone(Only if we may contact you at work): *Email Address: *Position in which you are interested: Pest Management Professional Sales Specialist Administrative Staff Branch Supervisor Branch Manager *Do you have a valid driver's license? Yes No *State of License: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *DL#: *Any motor vehicle accidents in past 10 years? Yes No *Any driving violations (other than parking) in last 10 years? Yes No *License or Registration ever suspended? Yes No *Have you ever been guilty of any crime other than a traffic offense? Yes No *Desired Location: Asheboro Boone Burlington Eden Elkin Greensboro High Point NW Greensboro Pittsboro South Greensboro South Winston Winston Salem *Have you ever been employed by Terminix Service Triad or any franchise of Terminix International? Yes No If yes, where and what position? *Do you have any relatives working for Terminix? Yes No If applying for a clerical position, please provide your WPM: Please list any other skills (adding, keypunch, shorthand, filing, etc.): *When will you be available for work? *How did you learn about this job? *Do you have any previous experience in Pest or Termite Control? If yes, please explain: Number of years experience: *Level of school completed: *Current Employer: How Long? *May we contact your current employer? Yes No Employment History: (Begin with most recent): Employer: From: To: Job Description: Reason for leaving: Rate of Pay: Other information you may wish to provide:

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Bruce-Terminix Company ("Terminix") is a North Carolina corporation licensed by the Terminix International Company L.P., of Memphis, TN, as a Terminix licensee.
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