Employment Application Form

Personal Information

Name:*

First NameLast Name

Birth Date

MonthDayYear

Phone Number:*

Area CodePhone Number

E-mail Address:

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How were you referred to us?*

Others:

Upload Resume:

Upload a File

Job Skills & Training

Desired Position

Describe your skills:*

Training or Certifications:

Previous Employment

Previous Employment Please list two (2) of your previous employers

Are You Employed Now

YesNo

If Employed May We Contact Your Current Employer?

YesNo

Employer 1:

Name of supervisor

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job title

Job Duties

Reason for leaving

Start Date

Date

End Date

Date

Employer 2:

Name of supervisor

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Job title

Job Duties

Reason for leaving

Start Date

Date

End Date

Date

References

References Please list two (2) references that are familiar with your work life.

Reference 1

Name:*

First NameLast Name

Phone Number*

Area CodePhone Number

Years Known:*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Reference 2

Name:

First NameLast Name

Phone Number

Area CodePhone Number

Years Known:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

I certify that the facts set forth in the above employment application are true and complete to the
best of my knowledge. I understand that falsified statements on this application in any detail
shall be considered sufficient cause for disqualification from further consideration for hire or for
dismissal.
I authorize Clean Sweep LLC to make any investigation of my personal or employment history and
authorize any former employer, person, firm, corporation or government agency to give Clean Sweep LLC any information they may have regarding me. In consideration of Clean Sweep LLC review of
this application, I release Clean Sweep LLC and all providers of information from any liability as a result
of furnishing and receiving this information.
I further agree that, if employer, my employment can be terminated with or without cause and
with or without notice, at any time, at either Clean Sweep LLC or my option. I understand that no
personnel recruiter, interviewer or other representative of Clean Sweep LLC other than CEO/Owner has
any authority to enter into any agreement for employment for any specified period of time. I also
understand that any employment manuals or handbooks that may be distributed to me during the
course of my employment shall not be construed as a contract or contract by implication.

Sign*

Date Submitted*

Date