Applicant Information















YesNo

YesNo

YesNo


YesNo

Education



YesNo






YesNo






YesNo

References

Please list three professional references.


















Previous Employment











YesNo










v



YesNo













YesNo

Military Service







Disclaimer and Signature

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.

Additional Information

Please Complete This Section












DaysAfternoonsNightsWeekends


Full TimePart Time






Please list hours for each day you are available for work:








Disclaimer and Signature

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.