MBS Property Management, Inc.

PO Box 980338, West Sacramento, CA 95798  Ph (916) 373-9400  Fax (916) 372-8809  TDD (800) 735-2929

PERSONAL INFORMATION (Please Print Clearly)

NAME: PHONE: ()

OTHER PHONE: ()EMAIL: ()

ADDRESS:

StreetCityStateZip

DRIVER’S LIC. NO: STATE: _____ EXP: _____ SOCIAL SECURITY #: --

IS YOUR DRIVER’S LICENSE CURRENT AND VALID? YES NO

HAVE YOU EVER USED ANOTHER NAME: YES NOIf yes, please enter here:

  1. Have you ever been previously employed by MBS, Inc.? YES NO

If yes, list dates employed, position and location:

  1. Are you related to anyone currently employed by MBS, Inc.? YES NO

If yes, list name of person related to:

  1. Are you currently employed? YES NOIf yes, may we contact your current employer? YES NO
  1. Persons under 18 years of age must submit a work permit and parents contact information:

If you are a minor, please provide the name and address of parent or guardian:

  1. Can you, prior to employment, submit verification of your legal right to work in the United States? YES NO
  1. Have you ever been convicted of a felony? YES NO
  1. Are you bondable? YES NO
  1. Are you able to perform the duties of the job(s) for which you are applying without accommodations? YES NO
  1. Military Service: Have you ever served or currently serving in the armed forces? YES NO
  1. Referred to this position by:

POSITION APPLYING FOR

Position Sought:

Date you can start: / / Expected Salary:

If applying for site position, are you available after hours in case of emergencies? YES NO

Employment as a resident or maintenance manager may require you to live on the premises; therefore, how many people will be living with you? How many adults in addition to you?

All adults living with you will be subject to landlord checks and criminal background checks.

EDUCATION, TRAINING AND EXPERIENCE

Do you have experience in any of the following?

Maintenance areasOffice areas

Carpentry: YES NOGeneral Office Experience YES NO

Electrical: YES NOTyping: YES NO

Mechanical Repairs: YES NOComputer: YES NO

Painting: YES NOAccounts Payable: YES NO

Sheetrock Repair: YES NOWritten Correspondence YES NO

i.e., writing letters

Plumbing: YES NOSupervisor Experience: YES NO

Grounds Maintenance: YES NOWorking with numbers: YES NO

Other (List): Teaching: YES NO

Other (List):

Languages you read, speak or write:

High School:Number of years completed: Graduated? YES NO

College:Number of years completed: Graduated? YES NO

Degrees? Business School: Type of Training:

EMPLOYMENT HISTORY (Present and Past)

Starting with your most recent employer, please list below all present and past employment for a minimum of 10 years. Attach additional pages if necessary.

  1. EMPLOYER NAME: Phone Number: ()

Street: City: State: Zip:

Type of Business: Supervisor’s Name:

Your Position and Duties:

Describe any Advancements:

Date of Employment: From ______/______to ______/______(Enter Month and Year)

StartingEnding

Reason for Leaving: ______Salary: ______Salary: ______

  1. EMPLOYER NAME: Phone Number: ()

Street: City: State: Zip:

Type of Business: Supervisor’s Name:

Your Position and Duties:

Employment History, continued…

Describe any Advancements:

Date of Employment: From ______/______to ______/______(Enter Month and Year)

StartingEnding

Reason for Leaving: ______Salary: ______Salary: ______

  1. EMPLOYER NAME: Phone Number: ()

Street: City: State: Zip:

Type of Business: Supervisor’s Name:

Your Position and Duties:

Describe any Advancements:

Date of Employment: From ______/______to ______/______(Enter Month and Year)

StartingEnding

Reason for Leaving: ______Salary: ______Salary: ______

EMPLOYEE SCREENING

This company strives to maintain a safe and drug free workplace. All prospective employees will be subject to a criminal background check and drug test. In addition, references will be contacted for all prospective employees.

The information requested below is necessary for the specific position for which you are applying. No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered.

Any information regarding criminal history will be maintained confidentially.

Have you ever been convicted of a criminal offense, felony or serious misdemeanor? (Misdemeanor convictions for marijuana-related offenses that are more than two years old need not be listed.) YES NO

If yes, state the nature of the crime(s), when and where convicted, and disposition of the case:

Applicant’s SignatureDate

/ “This institution is an equal opportunity provider and employer.”
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found online at , or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing al of the information requested in the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, by fax (202) 690-7442 or email at .” /

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