Application for Employment

Date of Application: *

First Name: *

Last Name: *

E-Mail Address: *

Street Address: *

City: *

State: *

Zip: *

Daytime Phone Number: *

Evening Phone Number: *

Are you legally authorized to work in the United States?: *

First Position Desired: *

Second Position Desired:

Are you seeking full-time employment?: *

Location of interest: *

Date You Can start: *

Pay Range: *

Days and Hours You are Available: *

How did you learn about the jobs from Dependable Cleaners: *

If referred by a friend or family, please type their name here:

Have you ever applied to a position before: *

If yes, what was the date and position you applied for:

Please summarize special skills and qualifications acquired from past employment or other experiences that may qualify you: *

Employment History 1

Previous Employment Start Date: *

Previous Employment End Date: *

Company Name: *

Job title: *

Phone number: *

Immediate supervisor & title: *

Reason for leaving: *

Company Address: *

Responsibilities (less than 250 Characters): *

Hourly rate/salary: *

Start (per hr/week/month/year): *

Final (per hr/week/month/year): *

Employment History 2

Previous Employment Start Date:

Previous Employment End Date:

Company Name:

Job title:

Phone number:

Immediate supervisor & title:

Reason for leaving:

Company Address:

Responsibilities (less than 250 Characters):

Hourly rate/salary:

Start (per hr/week/month/year):

Final (per hr/week/month/year):

Employment History 3

Previous Employment Start Date:

Previous Employment End Date:

Company Name:

Job title:

Phone number:

Immediate supervisor & title:

Company Address:

Responsibilities (less than 250 Characters):

Reason for leaving:

Hourly rate/salary:

Start (per hr/week/month/year):

Final (per hr/week/month/year):

Educational Background

High School: *

College:

Other:

Please add any additional information you feel will further support your application:

Disclaimer

By submitting this application, I hereby certify that the statements made are true to the best of my knowledge. I understand that any willful misrepresentation of the essential fact may be reason for dismissal. I hereby give Dependable Cleaners permission to verify this information. I release Dependable Cleaners and all contacted persons from all liability that may issue from this verification process.

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