EmailMe Form - All Clear Inc. Official Job Application

Personal Information

Name *

First Last

Address *

City *

Zip *

Phone Number *

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

Email

Are you eligible to work in the United States? *

Yes

No

Are you able to lift 75lbs on a regular basis? *

Yes

No

Are you willing and able to work overtime? *

Yes

No

Are you good with heights? *

Yes

No

Do you have a valid Washington State drivers license and a clean driving record for the past 5 years? *

Yes

No

Are you willing to submit to a drug test and undergo a background check? *

Yes

No

This will only be for those who are considered for hire

What date are you available to start work? *

MM / DD / YYYY

EDUCATION:

Name Of School - Degree/Diploma - Graduation Date *

Start with your most recent

Skills and Qualifications: Licenses, Skills, Training, Awards.

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer: *

Address: *

Supervisor: *

Phone Number *

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

Your Position Title: *

Start Date *

MM / DD / YYYY

End Date *

MM / DD / YYYY

If still employed, put today's date and indicate that below in Reason for Leaving

Responsibilities: *

Salary

Input hourly wage, if not salaried.

Reason for Leaving: *

Previous Position

Employer:

Address:

Supervisor:

Phone Number

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

Position Title:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

May We Contact Your Present Employer? *

Yes

No

Not working right now

References:
Name & Phone *

Questions, Comments and/or Explainations

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Type in the initials of your name

Todays Date *

MM / DD / YYYY