EmailMe Form - Victory Cleaning LLC

Today's Date:

MM / DD / YYYY

Date Available to start: *

MM / DD / YYYY

Full Name: *

First Last

Email: *

To receive notification of application.

Salary desired:

Desired Position: *

Type of employment desired: *

Full-time

Part-time

Temporary

Seasonal

Address: *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Current phone number: *

### - ### - ####

Social Security Number: *

(XXX-XX-XXXX)
This information is kept private and will never be shared with anyone outside Victory Cleaning HR Department.

Emergency phone number: *

### - ### - ####

Driver's License/ID #: *

State: *

How were you referred to us? *

If other, list here:

Have you ever worked for this company? *

Yes

No

If yes, when?

MM / DD / YYYY

Are you legally allowed to work in the United States? *

Yes

No

Are you under the age of 18 years old? *

Yes

No

If you are under 18 years of age, can you provide a work permit?

Yes

No

If no, please explain:

BACKGROUND

Answering 'yes' to these questions does not constitute an automatic rejection for employment. Date of offense, seriousness and the nature of the violation, rehabilitation and position applied for will be considered.

Have you ever pleaded guilty or been convicted of a crime? *

Yes

No

If Yes, give dates and details of convictions:

WORK EXPERIENCE

Please summarize your special skills or qualifications in complete sentences.

Upload your resume here:

(accepted formats: Microsoft Word/Adobe PDF)

PREVIOUS EMPLOYMENT

From:

MM / DD / YYYY

To:

MM / DD / YYYY

Company Name:

Position:

Address:

Street Address City State / Province / Region Postal / Zip Code Country / Region

Supervisor:

Phone:

### - ### - ####

Responsibilities:

Starting Salary:

Starting Title:

Ending Salary:

Ending Title:

Reason for leaving:

May we contact this employer for a reference?

Yes

No

From:

MM / DD / YYYY

To:

MM / DD / YYYY

Position:

Company Name:

Address:

Street Address City State / Province / Region Postal / Zip Code Country / Region

Supervisor:

Phone:

### - ### - ####

Responsibilities:

Starting Salary:

Starting Title:

Ending Salary:

Ending Title:

Reason for leaving:

May we contact this employer for a reference?

Yes

No

AGREEMENT

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, education, financial and other related matters such as many be necessary for an employment decision. I hereby release employers, schools, or individuals from all liability when responding to inquiries in connection with my application.

In that I am employed, I understand that false or misleading information given in my application or interview/s may result in immediate discharge.

Type Full Name here: *

Date: *

MM / DD / YYYY