Global Scheduling
Contractor Application Form
Step
1
of
2
50%
Vendor/Contractor Application
Full Name
*
As shown on Federal Tax Return
First
Middle
Last
Date of Birth
*
MM slash DD slash YYYY
Alternate Name (If applicable)
First
Last
Tax ID Number (or SSN)
*
Contact Name
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Payment Address (If different from address above)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
Tax Exempt?
*
Yes
No
Service/Product Description
*
Housekeeping
Painter/Sheetrock repairs
Resurfacing
General Construction
Plumbing
Electrician
Other
Please Specify Service (If not listed above)
*
Agreement & Signature
The undersigned, the owner or authorized representative of Vendor does hereby represent and warrant that the disclosure statements herein are true
Agreement
*
I agree
Printed Name
*
First
Middle
Last
Criminal Background Check Authorization Form
Full Name
*
First
Middle
Last
Other Names Used (If applicable)
First
Middle
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Social Security / Tax Identification Number
Global Restoration Services is requesting your social security number (SSN) in order to expedite this check with De Leon Unlimited Inc. Your SSN will not be disclosed to anyone outside the company except as mandated by law.
Driver's License Number
Date of Issue
MM slash DD slash YYYY
In connection with my employment at Global Restoration Services, I hereby Authorize the De Leon Unlimited Inc. To conduct a security background check on me. I understand that this security check will cover information such as criminal history, education and employment, sanctions/exclusions, and professional license/certifications. I understand that this background check may include information from previous employers relating to my work experience. I hereby release GS and its employees, as well as the De Leon Unlimited Inc. and its employees, from all liability resulting from the furnishing of this information to Global Restoration Services. I certify that the statements made by me on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that any false statements made herein could void my consideration for employment, or could result in disciplinary action up to, and including termination.
*
I Agree
With few exceptions, you are entitled (at your request) to be informed about the information Global Restoration Services (GRS) collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review the information. Under Section 559.004 of the Texas Government Code, you are entitled to have GRS correct information about you that is held by us and is incorrect, in accordance with the procedures set forth in Global Restoration Procedures. The information that GRS collects will be retained and maintained as required by Texas records retention laws (Sec 441.180 et seq. Of the Texas Government Code) and rules. Different types of information are kept for different periods of time. *DOB is being requested in order to obtain accurate retrieval of records.
*
I Agree