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A Clean Sweep, Inc. Application for Employment

PRE-EMPLOYMENT QUESTIONNAIRE  |  EQUAL OPPORTUNITY EMPLOYER

Personal Information

 NAME (LAST NAME, FIRST NAME, MIDDLE INITIAL)

 

 SOCIAL SECURITY NUMBER

     

 CURRENT ADDRESS

 

 CITY  STATE  ZIP CODE
 PERMANENT ADDRESS

 

 CITY  STATE  ZIP CODE
 PHONE NO.

()

 REFERRED BY

Employment Desired

 POSITION

 

 DATE YOU CAN START  SALARY DESIRED
 ARE YOU EMPLOYED?

YES NO

 IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER?

YES NO

 HAVE YOU EVER APPLIED TO THIS COMPANY BEFORE?

YES NO

 WHERE?  WHEN?

Education History

NAME & LOCATION OF SCHOOL

 YEARS ATTENDED  DID YOU GRADUATE?  SUBJECTS STUDIED
 GRAMMAR SCHOOL        
 HIGH SCHOOL        
 COLLEGE        
 TRADE, BUSINESS OR
 OTHER SCHOOL
       

General Information

 SUBJECTS OF SPECIAL STUDY/RESEARCH WORK OR SPECIAL SKILLS OR TRAINING

 

 U.S. MILITARY OR NAVAL SERVICE

 

 RANK

 

Former Employers (LIST BELOW LAST 4 EMPLOYERS, STARTING WITH LAST ONE FIRST)

DATE (MONTH AND YEAR)

NAME & ADDRESS OF EMPLOYER

SALARY

POSITION

REASON FOR LEAVING

 FROM        
 TO
 FROM        
 TO
 FROM        
 TO
 FROM        
 TO
 

 

References

NAME

 ADDRESS

BUSINESS

YEARS KNOWN

       
       
       

Authorization

"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I also understand and agree that no representative the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and any other relevant federals and state laws."

 

DATE SIGNATURE

INTERVIEWED BY DATE

 

DO NOT WRITE BELOW THIS LINE

Remarks

 

 

 

 

 

 

 

 NEATNESS CHARACTER
PERSONALITY ABILITY
HIRED FOR
DEPT.
POSITION WILL
REPORT
SALARY
WAGES

 

APPROVED:

1.

2. 3.
EMPLOYMENT MANAGER DEPARTMENT HEAD GENERAL MANAGER