Employment Application Form

THIS FORM HAS BEEN DESIGNED TO COMPLY WITH STATE AND FEDERAL FAIR EMPLOYMENT PRACTICE LAWS PROHIBITING DISCRIMINATION ON THE BASIS OF AN APPLICANT'S AGE, SEX, RACE OR NATIONAL ORIGIN
Employment Type Preferred*

Full TimePart Time
Name:*

First NameLast Name
Birthdate:*

MonthDayYear
Are you 18 years of age or older?*

YesNo
Phone Number:*

Area Code eg +65Phone Number
E-mail Address:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Major Cross Streets*
Referred By
Are you legally eligible to work in the United States?*

YesNoOther
Have You Ever Been Convicted of a Crime or Misdemeanor Other Than a Traffic Offense? If Yes, Explain
Emergency Contact Name:*

First NameLast Name
Emergency Contact Number:*

Area Code eg +65Phone Number
Relationship to applicant in case of emergency
To allow us to contact incase of any emergency
Past Cleaning Experience

less than 1 year1 year to 2 yearsMore Than 2 years
If you have cleaning experience, explain
Do you have a valid drivers license?*

YesNo
Applicants mode of transport use*

Public TransportOwn VehicleOther
Job Skills & History
Describe your skills (optional):
OPTIONAL
Current Employer*
Hourly Rate or Salary Amount
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Employer 01*
Current or last previous employer
Hourly Rate or Salary Amount
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for leaving
Date Cease employment

MonthDayYear
Date
Previous Employer 02
Current or last previous employer
Hourly Rate or Salary Amount
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for leaving
Date Cease employment

MonthDayYear
Date
If Presently Employed List Hours You Work*
Number of Where You Work

Area CodePhone Number
Do you have any physical defects that preclude you from performing any work for which you are being considered?

YesNo
Were You Ever Injured? If Yes, Give Details
Have You Any Defects in Hearing? Vision? Speech?

YesNo
What location are you applying for?*
Is there any reason that you are applying for this position?*
Date you can start

MonthDayYear
Date
Do You Prefer to Work Alone, With Other People, Or Does It Not Matter?*

AloneWith peopleDoes not matter
Hours You Can Work*

6am - 2pm6pm - 2amMidnight - 6am5pm - 2amPart Time DayPart Time Night
I HEREBY AFFIRM THAT THE ANSWERS TO THE ABOVE ARE TRUE AND CORRECT TO THE BEST OF MY RECOLLECTION AND UNDERSTAND THAT ANY FALSIFICATION CAN RESULT IN MY DISCHARGE IF I AM EMPLOYED. I HAVE READ THE CONDITIONS OF EMPLOYMENT AND AGREE TO ABIDE BY THESE CONDITIONS.*

I acceptI do not accept
I hereby authorize all corporations, companies, credit agencies, schools, government agencies, persons, military services, and former employers to release information they may have about me to Romaco Building Services, Inc. or its agents and employees, and release all persons or companies from any liability or responsibility from doing so. Further, I authorize the procurement of a consumer report and credit check, and understand that such a report may contain information about my background, character, and personal reputation. I understand that this notice will also apply to any future update reports that may be requested, including Drug Testing.*

I acceptI do not accept
Please verify that you are human*
Appointment
Should be Empty: