Bug-A-Way Job Application

1

Which Position Are You Applying For?* This field is required.Select your preferred method of communication.

Service Technician

Administrative Assistant

2

Full Name:* This field is required.

Please enter your first and last name

3

Phone Number:* This field is required.

Please list the best number for us to contact you with.

4

Email:* This field is required.

5

Address* This field is required.If you have lived at this address less than 6 months please include your previous address

6

Current or Previous Employers* This field is required.Please list up to 3 previous employers

7

Reason For Leaving Your Last Job:* This field is required.

8

May We Contact Your Previous Employers?* This field is required.

Yes

No

9

Please provide a reason why we can not contact your former employer?

10

References* This field is required.Please list 2-3 References

12

Please list any special skills or qualifications.

13

Have you ever been convicted of a felony?* This field is required.

Yes

No

14

Are you eligible to work in the United States?* This field is required.

Yes

No

15

Are you at least 18 years of age?* This field is required.

Yes

No

16

Do you have a Missouri driver's license?* This field is required.

Yes

No

17

Have been issued any traffic tickets in the past 3 years?* This field is required.

No Traffic Tickets

Yes 2 or more traffic tickets

Yes 1 Traffic Ticket

Other

18

Have you been involved in any at fault accidents in the past 3 years?* This field is required. Go ahead, tick as many as you need to:

No Accidents

Yes one at fault accident

Yes more than one at fault accident

Other

19

Are you able to lift 50lbs?* This field is required.

Yes

No

20

When are you able to start?* This field is required.

Date

21

Is there anything else you’d like to tell us?

22

Add Your Resume (Optional)

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