Personal Information
Current Address


Previous Address



Contact Information
What Would You Like To Do At House Calls?

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Start Time
Stop Time
What Schools Have You Attended?
School Level Name and location of school # of years attended Did you graduate? Subjects studied
Grammer School
High School
Trade Business or Correspondence School
Former Employers

List below the last three employers, starting with the last one first.


Give below the names of three persons not related to you. Whom you have known at least one year.

Other Important Information

If I am hired by House Calls, LLC, I agree that I will be an at-will employee, which means that either House Calls, LLC or I may end my employment at any time with or without cause or notice. I agree that no written materials or verbal statements by House Calls, LLC will constitute an express or implied contract of continued employment and that this at-will relationship can only be modified in writing by House Calls' President. I agree that, if hired, I will obey House Calls, LLC rules, including treating confidentially and information I learn during my employment.

I am not a current user of illegal drugs and I agree that I will never work under the influence of drugs or alcohol.

There is nothing in my background what would cause a risk to House Call's clients, employees or property. I authorize House Calls to conduct reference checks, criminal and driving record checks, and other consumer report investigations. I release all parties from any liability from providing such information to House Calls in this regard. I understand that conviction of a crime will not necessarily disqualify me from employment. I understand that the nature and the relevance of the offense to the position(s) applied for will determine my elgibility for employment.

I certify that the information I have provided to House Calls is true and complete, I agree to notify House Calls immediately if I am later charged with any crimes or (if I am a driver) with a driving offense. I agree that any false information or omission allows House Calls to refuse to hire me, or to terminate my employement at any time.