Employment Application - Swept Away Cleaning & Janitorial Inc

Application Date*

Certification*

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email

Mode of Transportation*

Are you willing to work any shift, including nights and weekends? If no, please state any limitations.*

Work Shift Limitations

Date You Can Begin Working*

If hired, are you able to submit proof that you are legally eligible for employment in the United States?*

Are you willing to submit to random drug testing?*

Are you willing to submit to a background check?*

Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?*

If no, what reasonable accommodation, if any, would you request?

Applicant's Employment History

Employer #1

1. Company Name*

1. Supervisor's Name*

First Last

1. Employer's Address*

Street Address Address Line 2 City State ZIP Code

1. Job Duties*

1. Reason for Leaving*

1. Start/End Date (MM/YY - MM/YY) *please enter both dates*

Employer #2

2. Company Name

2. Supervisor's Name

First Last

2. Employer's Address

Street Address Address Line 2 City State ZIP Code

2. Job Duties

2. Reason for Leaving

2. Start/End Date (MM/YY - MM/YY) *please enter both dates

Employer #3

3. Company Name

3. Supervisor's Name

First Last

3. Employer's Address

Street Address Address Line 2 City State ZIP Code

3. Job Duties

3. Reason for Leaving

3. Start/End Date (MM/YY - MM/YY) *please enter both dates

Applicant's Education and Training

Did you receive a High School Degree or Equivalent?*

Did you attend a college?*

College Name

College Address

Street Address Address Line 2 City State ZIP Code

Did you receive a degree?

List any other training (Graduate/Technical/Vocational)

Other Training

Military Service (list branch and any specialized training)

Please indicate any licenses or certifactions that you hold

Please indicate any Awards, Honors, Special Achievements

Emergency Contact Information

Who should be contacted if you are involved in an emergency?

Emergency Name*
First Last

Emergency Address*
Street Address Address Line 2 City State ZIP Code

What is your relationship with your Emergency Contact?*

Emergency Contact's Phone Number*

References: List any two non-relatives who would be willing to provide a reference for you.

1. Reference's Phone Number*

1. Reference's Name*
First Last

1. Reference's Address*
Street Address Address Line 2 City State ZIP Code

1. Relationship to you*

Second Reference

2. Reference's Phone Number*

2. Reference's Name*
First Last

2. Reference's Address*
Street Address Address Line 2 City State ZIP Code

2. Relationship to you*

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with your current employer.

Other Info