Employment Application

Clean Pro / Clean Tech is an Equal Opportunity Employer.  All individuals are considered for employment, and compensation based upon qualifications and availability, without regard to race, ethnicity, religion, sex, disability, marital status, sexual orientation, veteran status, or any other protected classification.

Availability

We rely upon the information you provide in determining whether to hire you. You will be expected to be available for scheduling during the times you listed below.

* denotes a required field

Position Applying For*:

Available Start Date*:

Salary Desired*:

Desired Schedule*:

Days and Times Available*:
Open Availability Monday AM Monday PM Tuesday AM Tuesday PM Wednesday AM Wednesday PM Thursday AM Thursday PM Friday AM Friday PM Saturday AM Saturday PM Sunday AM Sunday PM 


Personal Information

First Name*:

Last Name*:

Middle Initial:

Current Street Address*:

Current City*:

Current State*:

Current Zipcode*:

Previous Street Address*:

Previous City*:

Previous State*:

Previous Zipcode*:

Primary Phone Number*:

Secondary Phone Number:

Email Address*:

Are you over the age of 18?*:  Yes No


Employment History

List all employment, starting with your most recent position. Failing to provide all information for each employer may result in rejection of your application

Employer:

Date Started:

Date Ended:

Position/Title:

Duties Performed:

Employer City:

Employer State:

Employer Phone Number:

Supervisor:

Reason for Leaving:

Hourly Rate / Salary:

Employer:

Date Started:

Date Ended:

Position/Title:

Duties Performed:

Employer City:

Employer State:

Employer Phone Number:

Supervisor:

Reason for Leaving:

Hourly Rate / Salary:

Employer:

Date Started:

Date Ended:

Position/Title:

Duties Performed:

Employer City:

Employer State:

Employer Phone Number:

Supervisor:

Reason for Leaving:

Hourly Rate / Salary:

Have you ever been disciplined, terminated, or asked to resign by any employer?*:  Yes No


Education

High School Name*:

High School City*:

High School State:

Degree/Area of Study*:

Number of Years Completed*:

Graduated?*:  Yes No

College School Name*:

College School City*:

College School State:

Degree/Area of Study*:

Number of Years Completed*:

Graduated?*:  Yes No

Other School Name*:

Other School City*:

Other School State:

Degree/Area of Study*:

Number of Years Completed*:

Graduated?*:  Yes No

Special Skills/Courses*:


Criminal Conviction Information

All Applicants: In response to the questions that follow, you are not requested to provide information regarding convictions that have been sealed, expunged, annulled, or erased. Conviction does not necessarily bar your employment.

Have you ever been convicted of a felony?*:  Yes No

Felony Date:

Nature of Felony:

Have you ever been convicted of a misdemeanor involving weapons, theft, dishonesty, or violence?*:  Yes No

Misdemeanor Date:

Nature of Misdemeanor:


Miscellaneous

Are you legally authorized to work in the United States?*:  Yes No

How were you referred to Clean Pro/Clean Tech?*:

List the names of friends/relatives now employed by Clean Pro/Clean Tech*:

Have you ever been employed by Clean Pro/Clean Tech? If yes, please list dates*:


References

Name*:

Address*:

Phone*:

Relationship/Title*:

Years Known*:

Name*:

Address*:

Phone*:

Relationship/Title*:

Years Known*:

Name*:

Address*:

Phone*:

Relationship/Title*:

Years Known*:


Person to Contact in Case of Emergency

This information is to facilitate contact in the event of an emergency and is not used in the selection process.

Full Name*:

Address*:

Phone*:

Relationship*:


Please Read this Statement Carefully

I understand and agree that, if hired, my employment with Clean Pro/Clean Tech can be ended at any time, for any reason, by you or the management of Clean Pro/Clean Tech – with or without notice. If hired, my compensation and schedule are also subject to change at Clean Pro/Clean Techs discretion.

I Authorize Clean Pro/Clean Tech to contact the former employers, educational institutions, and references listed in this application. I authorize those entities and individuals to provide all information that Clean Pro/Clean Tech might request in considering my application for employment, or if hired, in connection with any investigation of me during my employment. I release Clean Pro/Clean Tech and all other persons from any and all liability or damage that may result from this information being furnished to Clean Pro/Clean Tech.

I further agree to take any lawful examination or test required by Clean Pro/Clean Tech as a condition of my being hired, or if I am hired, as a condition of my continued employment. I agree that my refusal to take any such lawful examination or test will result in my immediate termination.

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am hired, false statements on this application or during my interview my result in immediate termination. I further understand that if I am hired, I am required to abide by all rules and policies of Clean Pro/Clean Tech. An offer of employment may be conditioned upon the applicant's submitting to pre-employment drug screening.

If my employment is terminated as a result of conduct involving dishonesty (e.g., theft, lying, and similar conduct) I authorize Clean Pro/Clean Tech to report that information, along with any statement I might sign admitting the same, to the theft contributory database. I understand that Clean Pro/Clean Tech is not responsible for what happens to that information after it is reported. I release Clean Pro/Clean Tech and all other persons from any and all liability or damage that may result from such reporting.

I also understand that this application will be held for consideration for employment, on active file for a period of 60 days. If I still wish to be considered for employment after 60 days, I will need to fill out a new application.

I agree that I will not file any action suit of claim relating to my employment by Clean Pro/Clean Tech more than six months after the termination of my employment. I expressly waive any statute of limitations to the contrary.

Electronic Acceptance:

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