Employment Application
*Required
First Name:*
Last Name:*
M.I.
Address:* Street - Apartment/Unit #: City, State Zip:
Home Phone:
Cell Phone:
Work Phone:
Email:
Date of Birth:* ---JanFebMarAprMayJunJulAugSepOctNovDec ---01020304050607080910111213141516171819202122232425262728293031 ---20001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930
Social Security No.:
Desired wage:
What led you to contact us for employment?
Are you a citizen of the United States? Yes No
If no, are you authorized to work in the U.S.? Yes No
Have you ever worked for this company? Yes No
If so, when?
If yes, reason for leaving:
Do you have friends or relatives working for Clean Sweep? Yes No
If yes, provide name(s):
Have you ever been convicted of a felony?Conviction will not necessarily disqualify applicant from employment. Yes No
If yes, explain:
Do you have a reliable vehicle? Yes No
Do you have a valid driver's license? Yes No
Are able to preform all the essential functions of the job for which you are applying, with or without accommidation? Yes No
If hired, do you agree to abide by the safety rules of the company? Yes No
If hired, is there anything that may prevent you from reporting to work each scheduled day? Yes No
If yes, please explain:
HOURS AVAIlABLE: e.g. 5:00pm-12:00am Sunday: Monday: Tuesday: Wednesday: Thursday: Frdayi: Saturday:
REFERENCES: Full Name: Relationship: Company: Phone: Full Name: Relationship: Company: Phone:
SKILLS: Please lise all related job skills (i.e. strip and wax, buffing, other flooring or cleaning experience)
PREVIOUS EMPLOYMENT: 1. Company: Phone: Address: Street - Apartment/Unit #: City, State Zip: Supervisor: Job Title: Starting Salary: Ending Salary: Responsibilities: From: To: Reason for leaving: May we contact your previous supervisor for a reference?
2. Company: Phone: Address: Street - Apartment/Unit #: City, State Zip: Supervisor: Job Title: Starting Salary: Ending Salary: Responsibilities: From: To: Reason for leaving: May we contact your previous supervisor for a reference?
3. Company: Phone: Address: Street - Apartment/Unit #: City, State Zip: Supervisor: Job Title: Starting Salary: Ending Salary: Responsibilities: From: To: Reason for leaving: May we contact your previous supervisor for a reference?
MILITARY SERVICE: Branch: From: To: Rank at Discharge: Type of Discharge: If other than honorable, explain:
Athorization, please check box to authorize.... If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I also understand that any employment may be conditioned on a background check and drug test. I authorize Clean Sweep Janitorial to thoroughly investigate all statements contained in my application and I authorize my former employers and references to disclose information regarding my former employment, character and general reputation to the Company, without giving me prior notice of such disclosure.
* I certify that my answers are true and complete to the best of my knowledge.
* I accept these terms and conditions.
* Type the characters you see in the picture below