Sides Commercial Cleaning

Date:

9/8/2010

Personal Information

First Name:

Middle Name:

Last Name:

Social Security Number:

Present Street Address:

Present City:

Present State:

Present Zip:

Permanent Street Address:

Permanent City:

Permanent State:

Permanent Zip:

Phone Number:

I am 18 years or older.

DO NOT answer any of the questions contained in this box unless instructed otherwise.
I am a U.S. citizen.
Height:	feet, inches
Weight:	lbs.
*Date of Birth:
Fluent foreign languages:	Speak: Read: Write:
** I have been convicted of a felony or misdemeanor within the last 5 years.
Describe:
I understand and agree that I may be required to take one or more physical examinations and/or lie detector tests as a condition of hiring or continued employment. I agree to consent to take such tests at such time as designated the Company and to release the Company, its directors, officers, agents or employees from any claim arising in connection with the us of such tests.
I have been advised that lie detector tests, as a condition of hiring or continued employment, are prohibited by law.
The Age Discrimination in Employment Acto of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less then 70 years of age. *You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

Employment Desired

Position:

Starting Date:

Salary Desired:

I am currently employed at:

You may contact my current employer.

I have applied with this company before.

Where?

When?

Education

	Name and Location of School	Number of years attended	Did you graduate?	Subjects studied
Grammar school
High school
College
Trade, business or correspondence school

Former Employers (List last one first)

Name and Address of Employer	From: Month and Year	To: Month and Year	Salary	Position	Reason for leaving

References (Give the names of three persons not related to you whom you have known at least one year.)

Name	Address	Business	Years Acquainted

Physical Record

I have some physical limitation that preclude me from performing some work for which I may be considered.

Describe:

In case of emergency notify:

Name:

Address:

Phone Number:

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 statments in this application shall be grounds for dismissal.

I authorize investigation of all statments contained herein and the references listed above to give you any and all information concering my previous employment and any pertinent information they may have personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice.