Clean Sweep Employment Application Form

Clean Sweep Chimney Solutions - Employment Application
Name:*

First NameMiddle InitialLast NameSuffix
Other Names by which you have been known (if any)

First NameMiddle InitialLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
Home Phone

Area CodePhone Number
Mobile Phone*

Area CodePhone Number
E-mail Address:*
Emergency Contact*

NamePhoneE-Mail

Employment History

Please list your most recent or relevant previous job
Current or Most Recent Employer:*
Name of Employer
Address
City, State, Zip
Last Position You Held:
Immediate Supervisor(s)
Phone Number(s)
Dates of EmploymentMost Recent Salary or Hourly Rate
Job Title and Responsibilities
Hours worked per Week Reason for Leaving
May we Contact this Employer?*
Job Title and Responsibilities
References

Please list two 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
Click to edit

1. Can you provide proof of eligibility to become employed in the United States?*
If no on #1, are you able to provide such proof which will be required upon employment if you are offered a position?
2. If you are under the age of 18, can you provide required proof of your eligibility to work?*
3. Have you ever filed an application for employment with us before?*
If Yes, set forth dates of your application:
MonthDayYear
4. Are you currently employed?*
If currently employed and you do not wish for us to contact your employer, please set forth the reasons why:
5. Are you currently on layoff status and subject to recall?*
6. Do you have adequate transportation to meet travel requirements of the job?*
7. Do you have a current valid drivers license?*
If yes, please state the following:
Issuing StateExpiration Date
8. Are you able and willing to travel for this job if travel is necessary?*
9. Are you aware of any reason that may restrict your ability to perform the essential functions of the job for which you are making application?*
If yes, please explain and describe what accommodations might be necessary:
10. Have you ever been terminated or forced to resign from your employment with any employer?*
If yes, please explain:
11. Have you ever been convicted of a crime including any driving and/or alcohol related offenses?*
If yes, please explain:

Company Policies
Enter One or All of the Policies into this box
You must accept all Company Policies to proceed with the application process

Accept Policies
By Submitting this application I understand that the Company requires its employees to adhere to the highest standards of business and personal ethics and responsibility. I understand that the Company believes that one method by which such high standards are demonstrated is through the timely meeting of financial obligations. Consequently, I understand and agree that by making application for a position with this company, I am agreeing that my credit worthiness is substantially related to the job for which I am applying or which I hold and that my credit worthiness may be examined by the company. I further understand and agree that this application is not a contract of employment. I understand and agree that the Company adhere to a policy of employment at will which means that either I, or the employer, may terminate my employment at any time, or for any reason, consistent with application of state and federal law. I further understand that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is in a written employment contract naming me and signed by the President of the Company. I understand that to be employed, I must be lawfully authorized to work in the United States and must show the employer documents to prove this. I understand that the Company may investigate my work and personal history and verify the information provided in this application, on related documents or information obtained through other sources and I hereby authorize such investigation. I authorize all individuals, schools, firms and business named in this application or in other documents or interviews, except my current employer if I have so designated in this application, to provide complete and accurate information regarding my relationship with them to the Company. I further release those individuals, schools, firms and business and the Company from any and all liability for damage for providing or requesting such information. I certify under penalty of perjury that all of the information provided in the entire application process including any information provided in addition to this application including, but not limited to, information provided in resumes or interviews is true and correct. I understand that if there is any falsification or omission, this may lead to the Company’s refusal to hire me or a determination, at any time, that my employment should be terminated. The Company is an Equal Employment Opportunity Employer and considers all applicants without regard to race, color, religion, gender, national origin, age, marital status, veteran’s status, the presence of a mental, physical or sensory disability, sexual orientation, or any other legally protected status. Employment shall be based solely on the needs of the companies and the qualifications of the individuals making application.
Should be Empty:

Clean Sweep Chimney Solutions - Employment Application

Employment History

References

Reference 1

Company Policies