Employment Application

Applicant Information

Name*

First Last

Phone*

Email*

Driver's License #*

Social Security #*

Date of Birth*

Address*

Street Address Address Line 2 City State ZIP Code

Position(s) applying for:*

Available to state:*

How were you referred to the company?*

Applying Position

Regular part-time work?*

Regular full-time work?*

Temporary work?*

(Such as summer or holiday)

From:

If applying for temporary work, when will you be available?

To:

Can you work on the weekends?*

Can you work evenings?*

Are you available to work overtime?*

Salary desired?*

What days and hours are you available to work?*

Personal Information

Note: S&J Cleaning Services, LLC complies with the Americans with Disabilities Act and will consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a new hire may be tested on skill/agility and may be subject to a medical examination conducted by a medical professional.

Have you ever applied to or worked for S&J Cleaning Services before?*

If yes, please explain:

Do you have any friends, relatives, or acquaintances working for S&J Cleaning Services?*

If yes, who?

First Last

What is your relationship to him/her?

If hired, would you have transportation to and from work?*

Are you over the age of 18?*

(If under 18, hire is subject to verification of minimum legal age.)

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?*

If hired, are you willing to submit to and pass a controlled substance test?*

Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation?*

If no, describe the functions that cannot be performed.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?*

Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that effect the description of the event, and the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case.

Education

High School Name*

High School Address*

Street Address Address Line 2 City State ZIP Code

Did you graduate high school?*

Number of years completed?

College/University Name

College/University Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Degree Earned

Have you served in the military?*

If yes, which branch?

Air Force
Army
Coast Guard
Marine Corps
Navy

Years of service?

Do you speak, write or understand any foreign languages?*

If yes, describe which languages(s) and how fluent of a speaker you consider yourself to be.

Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?*

If yes, please explain.

Employment History

Name of Employer - #1

Position

From (Date)

To (Date)

Name of Supervisor

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Duties

Reason for Leaving

May we contact this employer for references?

Would you like to add employer two?*

Name of Employer - #2

Position

From (Date)

To (Date)

Name of Supervisor

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Duties

Reason for Leaving

May we contact this employer for references?

Would you like to add employer three?*

Name of Employer - #3

Position

From (Date)

To (Date)

Name of Supervisor

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Duties

Reason for Leaving

May we contact this employer for references?

Would you like to add employer four?*

Name of Employer - #4

Position

From (Date)

To (Date)

Name of Supervisor

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Duties

Reason for Leaving

May we contact this employer for references?

References

List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.

Name*

First Last

Phone*

Occupation*

Relationship*

Number of Years Acquainted*

Name*

First Last

Phone*

Occupation*

Relationship*

Number of Years Acquainted*

Name*

First Last

Phone*

Occupation*

Relationship*

Number of Years Acquainted*

Name*

First Last

Phone*

Occupation*

Relationship*

Number of Years Acquainted*

Review and Sign

Please read and initial each paragraph then type your below in place of your signature.

I certify that I have not purposely withheld any information that might adversely effect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure employment and can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.*

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice.*

I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.*

Today's Date*

Applicant's Signature*

Type your name in place of a written signature.

Employment Application

Applicant Information

Applying Position

Personal Information

Education

Employment History

References

Review and Sign

Contact Info