Employment Application

Full Legal Name*

First NameMiddle NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Are you over the age of 18?*

YesNo
Can you speak English?*

FluentlySomewhatPoorlyNot at all
Can you speak Spanish?*

FluentlySomewhatPoorlyNot at all
Are you a US Citizen?*

YesNo
If no, are you authorized to work in the US?*

YesNo
Have you ever been convicted of a felony? (This does not automatically exclude you from employment )*

YesNo
If you answered YES above: please explain:
Have you ever worked for this company before?*

YesNo
If you answered YES above: please list the dates and job description:
Do you have reliable transportation?*

YesNo
Check one *

I am looking for Full time workI am Looking for Part time work

Please fill in the hours/times you are available to work in the chart below. (ex-8am-3pm)*

	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
From:
To:

I am willing to work in the following counties in Kentucky (check all that apply)

BooneKentonCampbellGrantNone of the above
Education History
High School
Did you attend high school?*

YesNo
High School Name
High School City, State
Years Attended
Did you graduate?

YesNo
College Education
Did you attend college?*

YesNo
College Name
Years Attended
Focus of Study
Graduated

YesNo
Other Education
Other education: (ex: Vocational)
Employment History
If you have no employment history because this is the first job you are applying for, please check here and skip to the next section: (MILITARY HISTORY)

first job
Most Recent Employer
Most Recent Employer Name
Dated Employed:

Date Started Date Ended

Month/Year:
Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Starting Salary
Ending Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
Supervisors Email and/or phone number
May we contact your previous employer for a reference?

YesNo
Second Most Recent Employer
Second Most Recent Employer Name
Dates Employed

Date Started Date Ended

Month/Year
Second Most Recent Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Starting Salary
Ending Salary
Type of work perfomed
Reason for Leaving
Supervisors Name and Position
Supervisors Email and/or phone number
May we contact your previous employer for a reference?

YesNo
Military History
Have you ever served in the Military?*

YesNo
Branch
Dates Served
Rank at Discharge
Type of Discharge
If other than honorable, please explain
Thank you for taking time to complete this job application. We will be in contact with you shortly. We look forward to you potentially becoming part of the ECT Cleaning Family.
Disclaimer and Submission of Application
Signature

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I certify that my answers are true and complete to the best of my knowledge. I understand that false or misleading information on my application or interview may result in my release.*

YESNo
Should be Empty:

Education History

High School

College Education

Other Education

Employment History

Most Recent Employer

Second Most Recent Employer

Military History

Disclaimer and Submission of Application