Pristine Clean

Pristine Clean Solutions

Employment application
Pristine Clean is committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including, but not limited to, race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.
PERSONAL BACKGROUND
Name*

First NameMiddle NameLast Name and middle initial
Birth Date*

MonthDayYear
Date
Current Address*

Street Address

CityState / Province

Postal / Zip Code
Previous Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency contact Person

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.
Driving is a requirement of the job. Is your license valid?*

YESNO
Do you have full time access to a RELIABLE vehicle*

YESNO
Is the vehicle covered by comprehensive liability insurance?*

YESNO
Are you able, at the time of employment, to submit verification of your legal right to work in the U.S.?*

YESNO

Would you have difficulty standing, bending, or kneeling in connection with performing necessary cleaning duties?*

YESNO
What hours are you available to work on the following week days?
MON*
TUE*
WED*
THU*
FRI*
Saturday
We generally don't work Saturdays, but may at times offer based on your availability
Sunday
We generally down work Sundays, but may at times offer based on your availability
if you are hired, when can you start *
Are you presently Employed*

YESNO
if yes may we contact your employer*

YESNONA

Name of most recent employer or company*
Position held at most recent employment *
Reason for leaving most recent job*
please include the dates you worked here
Telephone # of most recent job
Previous employer Name or Company*
The one befor your most recent
Position Held *
Reason for leaving *
Please include dates of emplyment
Telephone

Highest Level of Educaiton Completed *
Have you ever been arrested for a crimminal offence*

NoYes (explain)
Do you consent in having Pristine Clena Solutions running a comprehensive background screening*

YESNO
PERSONAL REFERENCES
in the folowing section please list the names of three persons not related to you, whom you have known for at least three years.
Name*
Occupation / relationship *
Phone Number *
Address
If available
Years Known*
Name*
Occupation / relationship *
Phone Number *
Address
If known
Years Known*
Name*
Occupation / Relationship*
Phone*
Address
If known
Years Known*
how did you hear about this position*

Pristine Clean Application for Employment - Continued

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS WHICH ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK THEM BEFORE SIGNING.
In signing this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I hereby authorize Pristine Clean to which I am applying, to conduct any investigation necessary concerning any part of my background related to the position I am seeking; including, but not limited to, the obtaining of a police report and driving record. I authorize any of the persons or organizations named in this application to provide complete information and records regarding my employment, education, character and qualifications. I release all parties from any liability in connection with the provision and use of such information.*

YESNO
I understand and agree that, if employed by Pristine Clean Solutions, I will be responsible for familiarizing myself with all rules and regulations of Pristine Clean as they presently exist or are later modified and that I will abide by its rules and regulations which I understand are subject to change.*

YESNO
I also understand that no representative of Pristine Clean Solutions has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment. I further understand that, if hired, my employment is for no definite period of timeand may be terminated by either party at any time*

YESNO
I have read, understand and agree with the above.
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
This application is current for only 60 days from the date above signed. At the conclusion of this time, if / have not heard from the employer and still wish to be considered for employment, it may be necessary to fill out a new application.
Should be Empty:

Pristine Clean Solutions

PERSONAL BACKGROUND

PERSONAL REFERENCES