Last Name (required)
First Name (required)
M.I.
Date
Street Address
Apartment/Unit #
City
State
Zip
Phone
Email
Desired Salary
Date Available
Position Applied for
Are you a citizen of the United States? YesNo
If no, are you authorized to work in the U.S.? YesNo
Have you ever worked for this company? YesNo
If so, when?
Have you ever been convicted of a felony? YesNo
If yes, explain
High School
Address
From
To
Did you graduate? YesNo
Degree
College
Other
Please list three professional references.
Full Name
Relationship
Company
Supervisor
Starting Salary
Ending Salary
Responsibilities
Reason for leaving
May we contact your previous supervisor for a reference? YesNo
Job Title
From v
Branch
Rank at Discharge
Type of Discharge
If other than honorable, explain
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I hereby authorize Stay Clean Solutions to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position for which I am applying. I understand that Stay Clean Solutions will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such an investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.
Please Complete This Section
Do you have any disabilities that would prevent you from completing the assigned job description successfully? If yes, please explain:
Do you have any reactions to any cleaning chemicals or materials? If yes, please explain:
Do you have your own transportation/own vehicle?
Is your vehicle insured?
Name of insurance company:
What are the make, model and year of your vehicle?
What is your license plate #
Have you ever been convicted of a crime/arrested?
If so, please explain:
What geographical area are you willing to commute? What radius? (5 miles, 10 miles, etc)
Any geographical area you are not willing to commute? If so, please list locations:
What major cross streets do you reside?
Are you available to work days, afternoons, nights or weekends? DaysAfternoonsNightsWeekends
Are you available to work Full TimePart Time
Are there any obstacles that would restrict you from coming to work every day/night and being on time? If so, please explain:
How many years of experience do you have in this field of work?
Explain job duties?
What types of equipment are you familiar with?
Why do you think that Stay Clean Solutions should select you? Please give a brief description of yourself describing your personality, short-term goals and long-term goals
Please list hours for each day you are available for work:
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
