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| Print application and fax or email to 910-457-9416 NEED A JOB EMAIL Pam @ DJ@ACMECLEANINGSERVICE.COM |
| ACME CLEANING SERVICE Equal Opportunity Application For Contract Labor Date ____/____/____ Please answer every question. Please write “None” or NA” in any space that does not apply to you. A. PERSONAL DATA 1. Name__________________________________________________________________ Last First Mi 2. Social Security No. __________/_______/__________ 3. Present Address__________________________________________________________ Number Street Apartment or Box __________________________________________________________ City State Zip _______-_______-__________ _______-_______-________ Cell Phone Number Home Phone Number 4. How long have you lived at the above address? ________________________________ 5. Previous Address_________________________________________________________ Number Street Apartment or Box _________________________________________________________ City State Zip 6. Date of Birth ______/______/______ Month Day Year 7. Have you ever been convicted of a crime other than minor traffic violations within the past 10 years? (An affirmative answer will not necessarily disqualify you from employment) Yes ______ No ______ Explain _________________________________________________________________ _________________________________________________________________ 8. Are you legally able to be employed in the U.S? Yes_________ No__________ 9. Have you had any change of name for any reason which we would need to enable us to investigate you background? Yes__________ No__________ If yes, explain: ___________________________________________________________ ________________________________________________________________________ A. DRIVER’S LICENSE INFORMATION 1. Do you have a valid drive’s license? Yes ____ No _____ If yes, Driver’s License # ______________________ State ____ 2 Do you have a C.D.L.? Yes ____ No ____ If yes, what class? _____ Expires: ______ 3. Do you have reliable transportation? Yes _____ No _____ Model _______ Year____ 4. Have you had any traffic violations other than non-moving violations in the last 5 years? Yes _____ No _____ 5. Have you ever been arrested for driving under the influence of alcohol? Yes ___ No___ If yes, please explain: _____________________________________________________ _______________________________________________________________________ 6. Have you ever had a driver’s license suspended? Yes ____ No _____ If yes, please explain: _____________________________________________________ _______________________________________________________________________ C. JOB REQUIREMENTS 3. How did you hear about ACME CLEANING ______________________________ 4. What date would you be able to start work with us? ______________________________ D. REFERENCES 1. Name _____________________ Occupation ____________________Years Known ___ Association _____________________ Telephone _______________________________ 2. Name _____________________ Occupation ____________________Years Known ___ Association _____________________ Telephone _______________________________ 3. Name _____________________ Occupation ____________________Years Known ___ Association _____________________ Telephone _______________________________ E. PREVIOUS EMPLOYMENT Begin with the most recent or present employer. Please account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name & supply business references. (Be sure to include both month & year on all dates of employment. EMPLOYER _____________________________ ADDRESS___________________________________________ DATES EMPLOYED ___________TO ___________SALARY ______________PHONE ____________________ JOB TITLE/DUTIES ___________________________________________________________________________ SUPERVISOR _____________________________________ REASON FOR LEAVING_______________________________________________________________________ MAY WE CONTACT THE ABOVE EMPLOYER? YES_____ NO _____ EMPLOYER ______________________________ADDRESS__________________________________________ DATES EMPLOYED ___________TO ___________SALARY ______________PHONE ____________________ JOB TITLE/DUTIES ___________________________________________________________________________ SUPERVISOR _____________________________________ REASON FOR LEAVING _______________________________________________________________________ MAY WE CONTACT THE ABOVE EMPLOYER? YES_____ NO _____ EMPLOYER _____________________________ ADDRESS___________________________________________ DATES EMPLOYED ___________TO ___________SALARY ______________PHONE ____________________ JOB TITLE/DUTIES ___________________________________________________________________________ REASON FOR LEAVING_______________________________________________________________________ MAY WE CONTACT THE ABOVE EMPLOYEE? YES _____ NO _____ EMPLOYER _____________________________ ADDRESS___________________________________________ DATES EMPLOYED ___________TO ___________SALARY ______________PHONE ____________________ JOB TITLE/DUTIES ___________________________________________________________________________ REASON FOR LEAVING_______________________________________________________________________ MAY WE CONTACT THE ABOVE EMPLOYER? YES _____ NO _____ SIGNATURE___________________________________________ |
910-368-1603
877-728-6694
877-728-6694