CAREFULLY READ THIS SECTION PRIOR TO PROVIDING INFORMATION
I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete. I understand that any false or misleading representations or omissions made on the application or during the hiring process may disqualify me from further consideration for employment and may result in discharge even if discovered at a later date. I understand that employment may be conditioned upon successfully passing of drug screening as a condition for employment. I hereby authorize persons, schools, my current employer (if applicable) and previous employers and other organizations to provide this facility and its affiliates with any requested information regarding my application or suitability for employment, and I completely release all such persons or entities from any and all liability related to the providing or use of such information.
I understand that my employment is at-all which means that I may terminate the employment relationship at any time and for any reason with or without notice, and that Clarke’s Cleaning Concepts has the same right.
3C Employment Application
Your Name: (First, MI, Last)
Mailing Address:
Telephone Number:
Social Security Number:
Are you over 18 years of age? Yes No
Have you ever served in the military? Yes No
Have you worked for our organization before? Yes No
If yes, what year?
1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Under what name, if different from above?
Are you a U.S. citizen or an alien legally authorized to work in the United States? Yes No
Have you, since the age of 18, ever been convicted of a felony? Yes No
If yes, please explain: (Note: a conviction will not necessarily bar you from employment.)
Position:
2nd Choice:
Full-time Part-time Temp
Shift Preferred:
Days Evenings Nights
Salary Desired:
Would you consider working:
Weekends & Holidays Rotating On Call Any Shift
I am applying for the following (check all that apply) cleaning technician Field Associate Sales Office Personnel Other
Education
Name & Address
Graduated
Certifications
High School
Yes No
College/University
Other (specify)
Work history
(Please list most recent position first) May we contact your employer? yes no
Company Name
Telephone
Mailing Address
Dates Employed
From 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 To 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Your Job Title
Duties
Supervisor
Reason for Leaving
Salary
In addition to your work history, what other experiences, skills or qualifications would especially qualify you for work with our organization?
For Emergency Purposes List Three (3) Individuals We May Contact
Name
Relation
Address
Email Address: