Employment Application

Applicant Information
Last Name	First	M.I.	Date
Street Address		Apartment/Unit #
City	State	Zip
Phone	Email Address
Date Available	Desired Pay Rate
Position Applied for	Days & Hours Available
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?
Have you ever been convicted of a felony? Yes No	If yes, explain?

Previous Employment
Company 1	Phone
Address	Supervisor
Job Title	Starting Pay Rate	Ending Pay Rate
Responsibilities
From	To	Reason for Leaving
May we contact your previous supervisor for a reference? Yes No	Name & Phone#
Company 2	Phone
Address	Supervisor
Job Title	Starting Pay Rate	Ending Pay Rate
Responsibilities
From	To	Reason for Leaving
May we contact your previous supervisor for a reference? Yes No	Name & Phone#
Restaurant Cleaning Experience? Yes	Reason for leaving
Office Cleaning Experience? Yes	Reason for leaving
Retail Center Cleaning Experience? Yes	Reason for leaving
Auto Dealership Cleaning Experience Yes	Reason for leaving
Floor Work (Stripping/Waxing) Experience Yes	Tile Carpet Wood Pressure Washing Reason for leaving

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.
Digital Signature	Date

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