Employment Application

Position Applying For*
Application Date*
MM slash DD slash YYYY
How Did You Learn About Us?
- Advertisement
- Friend
- Walk-In
- Employment Agency
- Relative
Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Home Phone*
Cell Phone
Are you a U.S. Citizen or do you have the legal right to work in this country?*
- Yes
- No
Are you 18 years of age or older?*
- Yes
- No
Have you ever filed an application with us before*
- Yes
- No
If yes, give date
MM slash DD slash YYYY
Have you ever been employed with us before?*
- Yes
- No
If yes, give date
MM slash DD slash YYYY
Have you ever been convicted of a crime other than minor traffic violations?*
- Yes
- No
If yes, please explain fully
Are you currently employed?*
- Yes
- No
May we contact you current employer?*
- Yes
- No
On what date would you be available to start?*
MM slash DD slash YYYY
Are you currently on "lay off" and subject to a recall?*
- Yes
- No
Can you travel if a job requires it?*
- Yes
- No
The job for which you are applying includes cleaning floors of debris by sweeping, mopping, vacuuming, and disposal of refuse, cardboard, and trash. This may include the operation of mechanical sweepers, buffers, push brooms, and lifting trash containers up to 40 lbs.
Can you perform the essential functions described above without accomidation?*
- Yes
- No
If no, please describe any accommodating necessary to perform these functions.
When are you available to work?*
- Full Time
- Part Time
- Shift Work
- Temporary
If you can only work certain days please indicate the times you are available. If you are not available on a certain day, please mark "n/a".
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Emergency Contact Name
Emergency Contact Phone
Applicant's Background
Education*
Describe Course of Study*
Indicate any foreign languages you can speak, read, and/or write
List any professional, trade, business, or civic activiteis and offices held.
Have you had any job-related training in the military?*
- Yes
- No
If yes, please explain
References
Please provide the name, address, and telephone number of persons that are not related to you and are not your previous employer.
Reference #1 Name*
First Last
Reference #1 Address*
Street Address City State / Province / Region ZIP / Postal Code
Reference #1 Phone*
Reference #2 Name
First Last
Reference #2 Address
Street Address City State / Province / Region ZIP / Postal Code
Reference #2 Phone
Reference #3 Name
First Last
Reference #3 Address
Street Address City State / Province / Region ZIP / Postal Code
Reference #3 Phone
Employment History
Start with your present or last job. Included any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer # 1
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Job Title
Supervisor
Phone
Starting Date
MM slash DD slash YYYY
Ending Date
MM slash DD slash YYYY
Starting Wage
Ending Wage
Hours per Week
Please Describe Your Work Performed
Reason For Leaving
Employer #2
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Job Title
Supervisor
Phone
Starting Date
MM slash DD slash YYYY
Ending Date
MM slash DD slash YYYY
Starting Wage
Ending Wage
Hours per Week
Please Describe Your Work Performed
Reason For Leaving
Employer #3
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
Phone
Starting Date
MM slash DD slash YYYY
Ending Date
MM slash DD slash YYYY
Starting Wage
Ending Wage
Hours Per Week
Please Describe Your Work Performed
Reason For Leaving
Employer #4
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Job Title
Supervisor
Phone
Starting Date
MM slash DD slash YYYY
Ending Date
MM slash DD slash YYYY
Starting Wage
Ending Wage
Please Describe Your Work Performed
Reason For Leaving
Please summarize any special job-related skills and qualifications acquired from employment or other services.
Applicant Statement
I certify that answers given by me to all of the questions on this application are to the best of my knowledge and belief, true and correct, without mental reservations of any kind whatsoever. I further affirm that I have not knowingly withheld any facts or circumstances that would detrimentally affect this application. I understand that any false statement or omission of material facts shall be considered sufficient cause for dismissal.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. If I wish to be considered for employment beyond this time period I should inquire as to whether or not applications are being accepted at that time.

I understand that if I am employed by Clean Way Professional Cleaning Services, Inc., such employment does not constitute employment for any fixed or guaranteed period of time and that such employment, including any and all terms and conditions relating thereto whether presently in existence or adopted at some later date, is and are terminable in accordance with the policy, procedure, and practice of Clean Way Professional Cleaning Services, Inc.

I understand that neither this document or any offer of employment from the employer constitute and employment contract unless a specific document to that affect is executed by the employer and employee in writing. Should I become an employee of Clean Way Professional Cleaning Services, Inc. I elect to work in a tobacco-free, drug-free environment.

I understand, also, that I am required to abide by all rules and regulations of the employer.

By signing my name and dating this digital application, I agree to be bound by these terms.
Applicant Digital Signature
Date
MM slash DD slash YYYY

Applicant's Background

References

Employment History

Applicant Statement