Employment Application

Position: *

How did you learn of this opening?:

Date you could start: *

Rate desired: * $

Last Name: *

First Name: *

Middle Name:

Address Line 1: *

Address Line 2:

City: *

State: *

Zipcode: *

Home Phone: *

Work Phone:

Cell Phone:

Over 21?: *

Yes

Are you able to legally work in the United States?: *

Yes

Were you previously employed by Job Done Cleaning? If so, please provide employment dates, position title and department:

Have you ever been convicted of a felony or misdemeanor, other than minor traffic violations?: *

Yes

Do you have a valid driver's license?: *

Yes

Have you ever been fired or resigned from a position after being notified you would be fired?: *

Yes

Can you read and understand instructions written in English?: *

Yes

Do you have dependable transportation of your own?: *

Yes

Do you have prior cleaning experience?: *

Yes

References

Please give the names of 3 persons NOT related to you, whom you have known at least one year

Name #1:

Years Known:

Phone:

Occupation:

Name #2:

Years Known:

Phone:

Occupation:

Name #3:

Years Known:

May we contact this employer?: *

Yes

Day job start time: *

Day job finish time: *

Physical Record

Do you have any impairment that would interfere with your ability to perform the job for which you have applied?:

Are you currently receiving any disability benefits? : *

Yes

Emergency Contact

Please name another adult living at your residence that we may contact in case of emergency:

Name:

Relationship to you:

Phone:

Additional Emergency Contact

An additional emergency number other than your home

Name:

Relationship to you:

Phone:

High School or Highest Grade Completed

Name & Location:

Date From:

Date To:

Degree or # Of Credits Completed:

Date Graduated:

College or University

Name & Location:

Date From:

Date To:

Degree or # Of Credits Completed:

Date Graduated:

Graduate School

Name & Location:

Date From:

Date To:

Degree or # Of Credits Completed:

Date Graduated:

Business or Trade School

Name & Location:

Date From:

Date To:

Degree or # Of Credits Completed:

Date Graduated:

Employment History

List below present and past employment, beginning with the most recent. Include any related military service or volunteer work.

Follow this format:

Name of Employer / Address / Telephone# / Position held / Dates of employment / Supervisor

Employer 1:

Employer 2:

Employer 3:

Employer 4:

Employer 5:

Agreement

I certify that the statements in this application are true and complete to the best of my knowledge, and I agree that any intentional misstatement or omission will constitute grounds for unfavorable consideration of my application or dismissal from employment with Aimee's Cleaning Service, Inc.
I authorize Aimee's Cleaning Service, Inc. to obtain information from past employers and other sources to support the data on this application, including a review of my educational, criminal and credit records, as appropriate.

You may contact my PRESENT employer: *

Yes

If No, Please Explain:

Employment Agreement

I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without any previous notice

Date: *