Download - EMPLOYMENT APPLICATION Please Print and Completely ......Application will remain active for 30 days from above date 2 EMPLOYMENT APPLICATION (CONTINUED) EMPLOYMENT HISTORY (Cover the

Applicationwillremainactivefor30daysfromabovedate 1

EMPLOYMENTAPPLICATIONPleasePrintandCompletelyAnswerAllQuestions.

POSITIONAPPLIEDFOR:_______________________________ DATE:______________________________APPLICANTDATALastName First MiddleStreetAddress City State/ZipCodeHomeTelephoneNumber AlternativePhoneNumber__________________________________________________________________________________________EmailAddressWhenwillyoubeavailabletostartwork?________________________________________________________Areyouatleast18yearsold?Yes�No�Pleaseindicatedaysyou’reavailabletowork.Mon.�Tues.�Wed.�Thurs.�Fri.�Sat.�Pleaseindicatewhatshiftyou’reavailabletowork.1st�2nd�3rd�OfficeHoursOnly�Areyouavailabletoworkoutoftown,ifrequired?Yes�No�Areyouavailabletoworkovertime,ifrequired?Yes�No�AreyoulegallyauthorizedtoworkintheUnitedStates?Yes�No�Howdidyouhearaboutus?Current/FormerEmployee�Whoshouldwethank?_______________________Newspaper� Friend� RecruitingFirm� Walk-in� Other�_______________________

Completethissectiononlyifdrivingisindicatedasarequirementforthepositionwhichyouareapplying.Otherwise,skipthissectionandgotoEducation.DoyouhaveavalidDriver’slicense?No�Yes�State&LicenseNo.___________________________Haveyouhadanytickets?No�Yes�Explain_______________________________________________________________________________________________________________________________Hasyourlicensebeensuspendedorrevoked?No�Yes�Explain________________________________________________________________________________________________________________DoyouhaveanyDUIorDWIconvictions?No�Yes�Explain(Includedate)_______________________________________________________________________________________________________

CleantheWorldandallaffiliatesisanequalopportunityemployeranddoesnotdiscriminateagainstotherwisequalifiedapplicantsonthebasisofrace,color,religion,nationalorigin,age,sex,veteranstatus,disability,oranyotherbasisprohibitedbyfederal,state,orlocallaw.InaccordancewithAmericanswithDisabilitiesAct,itisourpolicytoprovidereasonableaccommodationuponrequestduringtheapplicationprocesstoeligibleapplicantsinorderthattheymaybegivenafullandfairopportunitytobeconsideredforemployment.CleantheWorldisadrugfreeworkplaceandparticipatesinE-Verify.


EMPLOYMENTAPPLICATION(CONTINUED)

EMPLOYMENTHISTORY(Coverthelastfiveyears.Startwithmostrecentemployer.Useadditionalpaperasneeded.Ifresumeprovidesemploymenthistoryandisattachedtoapplication,checkthisbox�andproceedtonextsection.)

DONOTLEAVEBLANKSPACES

CompanyName DatesEmployedFrom: To:Address RateofPayatTimeofSeparation

Seeattachedresumeforjobtitleanddutyinformation.�

CompanyName DatesEmployedFrom: To:Address RateofPayatTimeofSeparation______________ NameofSupervisor Tel#:()Maywecontact?Yes�No� ReasonforLeaving:StateJobTitlesandDescribeJobDuties:





EMPLOYMENTAPPLICATION(CONTINUED)

EDUCATIONDoyouhaveahighschooldiplomaorGEDequivalent?Yes�No�Ifthepositionyouareapplyingforrequiresspecificeducationortraining,completethissection.Ifnoadditionalseculareducationand/ortrainingisrequiredforthisposition,youcanskipthissection.School________________________ Degree___________________________Graduated?Yes�No�School________________________ Degree___________________________Graduated?Yes�No�School________________________ Degree___________________________Graduated?Yes�No�School________________________ Degree___________________________Graduated?Yes�No�Training_______________________________________________________________________Certificates/Licenses____________________________________________________________EDUCATIONALANDPROFESSIONALAFFILIATIONSconsideredrelevanttojob(Youneednotdisclosemembershipinprofessionalorganizationsthatmayrevealinformationregardingrace,color,creed,sex,religion,nationalorigin,age,disability,maritalstatus,oranyotherprotectedstatus.)____________________________________________________________________________________________________________________________________________________________________________________GENERALINFORMATIONAnswerallquestions.Donotleaveanyblanks.Haveyoueverbeendischargedorforcedtoresignbecauseofconductorapolicy/proceduralviolation?No�Yes�Explain__________________________________________________________________________________________________________________________________________________________________Haveyourecentlybeenlaidoffandareeligibleforrecallbyaformeremployer?No� Yes�Haveyoureceivedanydisciplinarycounselinginthelasttwelvemonthsofemployment?No�Yes�Explain____________________________________________________________________________________________________________________________________________________________________________________Haveyousignedanyemploymentagreementand/ornon-compete/non-solicitagreementwithanyotheremployerthatmightrestrictyoufromworkingforthiscompany?No�Yes�Explain____________________________________________________________________________________________________________________________________________________________________________________________________


ACKNOWLEDGEMENTANDAGREEMENTIcertifythattheanswersgivenhereinaretrueandcompletetothebestofmyknowledge.Iunderstandthatanymisrepresentations,omissionsorfactsorincompleteanswersinanyapplicationdocumentwilldisqualifymefromfurtherconsiderationofemployment.Ifurtherunderstandthat,ifemployed,anymisrepresentationsoromissionsoffactsinanyapplicationand/oremploymentdocumentswillbecauseformydismissalatanytimewithoutpriornotice.Iunderstandthat,ifemployedmyemploymentwithCleantheWorld(CTW)orCompanyisnotforaspecifictermandmaybeterminatedbymeorCTWwithorwithoutnoticeorcauseatanytime.Ifurtherunderstandthatnooralpromise,CTWpolicy,custom,businesspracticeorotherprocedure(includingtheEmployeeHandbookoranyotherpersonalmanual)constitutesanemploymentcontractormodificationoftheat-willemploymentrelationshipbetweenmeandCTW.Iunderstandthatapplicationsforcertainpositionsmayberequiredtoqualifyforemploymentbasedonadditionalemploymentcriteria.Forexample,Imayberequiredtotakejobrelatedtests;takeadriver’sexamination;submittoabackgroundinvestigation;takeapre-employmentdrugtest.IfIamofferedemploymenttostartworkbeforeanyrequiredtestiscompleted,myemploymentiscontingentonasatisfactoryresultonallrequiredtests.IauthorizetheCompanytocontactmyprioremployers,andothersourcesofinformationregardingmybackground,andIherebyauthorizeanddirecteachsuchemployerandsourceofinformationtoansweranyandallquestionsregardingmyprioremploymentandbackground.IherebyindemnifytheCompany,eachofmyprioremployers,andeachoftheothersourcesofinformationcontactedandagreetoholdharmlessfromanyclaimsarisingfromthisauthorizationanddirection.Iunderstandthatthisapplicationwillbeconsideredactivefor30-calendardaysfromthisdate.IfIhavenotheardfromthecompanyattheconclusionofthe30-calendardayperiod,itismyresponsibilitytocompleteanewapplicationifIwishtobeconsideredforemployment.APPLICANTSIGNATURE_______________________________ DATE________________________