Employment Application

Employment Application

4404 North Main St. | Columbia SC 29203 | Office (803) 754-6739
Position Desired
Rate Desired
Date

MonthDayYear
PLEASE READ BEFORE FILLING OUT THIS APPLICATION
The Civil Rights ACT of 1964 prohibits discrimination in employment practice because of race, color, religion, sex, or national origin. The Age Discrimination in Employment ACT prohibits discrimination on the basis of age with respect to the Individuals who are at least 40 years of age. The Americans with Disabilities Act of 1990 prohibits discrimination Because of disability. No question on this application is intended to secure information to be used for such discrimination.
APPLICANT’S STATEMENT:
I understand that this application will be given every consideration, but its receipt does not imply that the applicant will be employed. I understand that an investigative consumer report may be made whereby information is obtained through personal interviews with neighbors, friends and others with whom I am acquainted. This investigation includes information as to my character, general reputation, person characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. I give my permission to the company to contact any of my former employers or references shown below to verify the information I have given and to release all record of my employment, including assessments of my job performance, ability and fitness. I give my permission to the company to obtain from any law enforcement agency my criminal record if any such record exists. I understand that the company may require a criminal history release. I hereby state that the information given by me in this application is true in all respects, and I agree that if I am Employed and the information to be false in any respect that I am dismissed. Should I be employed I understand that such employment will be on a trial period for ninety working days from the date of hiring. I further understand that my employment will not result in an employment contract for any specific term.
Signature of Applicant

Clear
Date

MonthDayYear
Date
PERSONAL DATA: (Please Print)
Name
Present Address (Street and Number, City, State and Zip)
Cell Number
Please enter a valid phone number.
Date you can start

MonthDayYear
Are you over the age 18 (If no, employment is subject to verification that you are of minimum legal age.)?

YesNo
Are a citizen of the U.S.?

YesNoNo, but I am authorized to work in the U.S.
If so, what type of authorization do you have?
What transportation would you use to get to and from work?

PersonalPublic
Do you have a driver's license?

YesNo
Did you serve in U.S. ARMED FORCES?

YesNo
If yes, what branch did you serve?
Type of discharge?
Have you ever been convicted of, pled guilty, or no contest to a crime, excluding minor traffic violations?

YesNo
If yes, give details on each conviction:
Have you ever worked here before?

YesNo
If yes, when (Please give the month and year)?
Reason for leaving?
Can you operate a rider floor scrubber?

YesNo
If yes, how much experience?
Can you operate a propane buffer?

YesNo
If yes, how much experience?
Can you strip and wax tile floors?

YesNo
If yes, how much experience?
Can you work evenings?

YesNo
If so, what hours?
What days can you work (Please select all that apply)?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you currently employed?

YesNo
Where are you currently employed (Business name)?
Employer Address (Street and Number, City, State and Zip)
How long have you worked at your current employer?
What days do you work?
What days do you work (Please select all that apply)?

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What are your work hours?
Current job description

LIST THREE REFERENCE, OTHER THAN RELATIVES, THAT HAVE KNOWN YOU FOR AT LEAST TWO YEARS:

	Name	Telephone Number	Years Known
Reference 1
Reference 2
Reference 3

IN CASE OF ACCIDENT OR OTHER EMERGENCY WHOM SHOULD WE CONTACT?
Name
Relationship
Home Number
Work Number
Home Address (Street and Number, City, State and Zip)
Work Address (Street and Number, City, State and Zip)
PREVIOUS WORK RECORD: (START WITH MOST RECENT EMPLOYER)
1. Employer Name
Phone Number
Address (Street and Number, City, State and Zip)
Job Description
Start Date of Employment

MonthDayYear
End Date of Employment

MonthDayYear
Reason For Leaving
2. Employer Name
Phone Number
Address (Street and Number, City, State and Zip)
Job Description
Start Date of Employment

MonthDayYear
End Date of Employment

MonthDayYear
Reason For Leaving
3.Employer Name
Phone Number
Address (Street and Number, City, State and Zip)
Job Description
Start Date of Employment

MonthDayYear
End Date of Employment

MonthDayYear
Reason For Leaving
I certify that the information contained in this application is correct to the best of my knowledge and understand that false or omission of this information is ground for dismissal. I authorize the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from liability for any damage that may result from furnishing same to you. I agree to comply with the policies and directives of the company. I understand that this employment application and any other company documents are not promises of employment. I understand that my employment can be terminated with or without caused and with or without notice, at any time, at the option of either the company or myself. I understand that no manager or representative of the company, other than the president or owner, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
Signature

Clear
Date

MonthDayYear
If you have any questions, comments or concerns about this application please contact us via email at ewesley@wesleyjanitorial.com or
call (803) 754-6739.
Should be Empty:

Employment Application

PLEASE READ BEFORE FILLING OUT THIS APPLICATION

APPLICANT’S STATEMENT:

PERSONAL DATA: (Please Print)