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Employment Application

If you need help filling out this application form or for any phase of the employment process, please notify us and every effort will be made to accommodate your needs in a reasonable amount of time.

  1. Please read “Applicant Note” below.
  2. Complete all sections of this application..
  3. PLEASE ENTER: “NOT APPLICABLE” IF NOT ANSWERING A QUESTION.
  4. Provide only requested information. Failure to do so may result in disqualification of your application.

APPLICANT NOTE: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately.

False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. No question in this application is intended to elicit information in violation of any such law, nor will any information obtained in response to any questions be used in violation of such law.

A conviction record will not necessarily bar an applicant from employment.

Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you may be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.


Personal Information
   
Position Applied For:
Today's Date:
First Name: Middle Initial :
Last Name:
Home Phone: Cell Phone:
Street Address:
City: State:
Zip: County:
Prior Address:
City: State:
Zip:    
   
Availability
What date can you start?
What category would you prefer? Full Time    Part Time     Temporary    Labor Pool
For which work schedules are you available? Weekdays (8:30am to 5:30pm)   Weekends (10:00am to 6:00pm)   
Evenings (5:00pm to 10:00pm)    Other  

Reasonable efforts will be made to accommodate sincerely held religious beliefs and practices.
       
Job-Related Skills
NOTE: Do not fill out any part of this section that you believe to be non-job related.
Yes No If the job requires, do you have the appropriate valid drivers license?
Yes No Has your drivers license ever been suspended? If yes, explain:
 
Yes No Do you have full-time access to a vehicle?
Yes No Have you had any moving violations within the last seven years? Please describe.
 
Yes No Have you been given a job description or had the essential functions of the job explained to you?
Yes No Do you understand the essential functions of the job?
Yes No Can you perform the essential functions of the job with or without reasonable accommodation?
Yes No Are you able to lift 50 pounds or more?
Yes No Would you have difficulty standing, bending or kneeling in connection with performing necessary cleaning duties?
       
In which of the following industries have you worked? House Cleaning
Fast Food
Homemaker
Other		 Hotel/Motel
Janitorial Service
Manufacturing
 Restaurant
Sales
Service
       
Security
Please note that due to the security sensitive nature of our business, all employees are required to be bonded. As a matter of policy, the company conducts a SSN Search and verification, address verification and criminal background check on any applicant in consideration for hiring.
Yes No Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. Applicant is not obligated to disclose any reference to a pre or post trial diversion program, any conviction, which has been sealed, expunged or erased by the court. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of offense, remoteness of offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)
  Incident City/State Charge
 
 
       
Comments
       
Previous Employers
PLEASE NOTE: Your application will not be considered unless every question in this section is answered. Since we make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary.
Most Recent Employer
 Phone:
    Fax:
Yes No Are you currently working for this employer? Yes No If yes, may we contact this employer?
Company Name:
City: State:
Dates Employed: From To
Job Title: Supervisor Name:
Duties:
Salary: Per Reason for Leaving:
       
Second Most Recent Employer
 Phone:
    Fax:
Company Name:
City: State:
Dates Employed: From To
Job Title: Supervisor Name:
Duties:
Salary: Per Reason for Leaving:
       
Third Most Recent Employer
 Phone:
    Fax:
Company Name:
City: State:
Dates Employed: From To
Job Title: Supervisor Name:
Duties:
Salary: Per Reason for Leaving:
       
Personal References
NOTE: Include only individuals familiar with your work ability. Do not include relatives or names of supervisors listed above.
Name Address/Phone Years Known/Relationship
       
Education
NOTE: Do not fill out any part of this section that you believe to be non-job related.
Please select the highest grade completed: If your school records are under a different name than you previous listed, please enter that name:
       
Name City/State Graduated Degree Type
Yes No
Yes No
Yes No
       
Certification And Release
I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer-reporting bureaus, to verify any of this information. I release all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
       
How did you hear about us? Newspaper Ad   Flyer  
Referred By:     Other: 
       
       


NOTE: In connection with your application for employment, we may procure a consumer report on you as part of the process of considering your candidacy as an employee. To complete the application process, please print and fill out the following form and fax, mail, or deliver it in person to our offices.

Consumer Report Disclosure.pdf ( 13KB )
 
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