Employment Form

Today's Date Last Name First Name Middle Initial Address City State Zip Home Phone, Cell or Pager Email Have you worked in any cleanliness company before? When? Date you will be available to start work Have you worked in maintenance? Where? Have you ever been convicted of a felony? In what state? Explain Are you 18 years of age or older? Availability Full time (7-8 hours days) Part time (6 or less hours a day) Shift Desired Days Evenings Over Nights What days are you unable to work? What languages do you speak? Indicate the fluency level May we contact your current employer? Company Name Address Phone Dates of Employment - From (MM/YY) Dates of Employment - To (MM/YY) Name of Supervisor Job Title Responsibilities Reason For Leaving Starting Salary Ending Salary I have read the statement above and agree

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