Getz Industrial Cleaning Employment Application
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best time to call:
Type a label
Email
*
example@example.com
Position applied for:
*
Date of Application
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
How were you informed of this position?
*
Walk-in
Advertisement
Job Ad
Employee
Website
Other
Employee Referral
Are you legally eligible for employment in this country?
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Yes
No
Date available for work?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Will you relocate if job requires it?
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Yes
No
Will you travel if job requires it?
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Yes
No
Do you have a drivers license?
*
Yes
No
What is desired salary range or hourly pay?
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Pay per hour or per year?
*
Are you able to meet the attendance requirements of the position?
*
Yes
No
Will you work overtime if required?
*
Yes
No
If no, please explain:
Type of desired employment?
Full-time
Part-time
Educational Co-op
Seasonal
Temporary
Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)?
*
Yes
No
Need more information about the job's "essential functions" to respond
Have you entered into an agreement with any former employer or other party (such as a non-competition or non-solicitation agreement) that might, in any way, restrict your ability to work for our company?
*
Yes
No
If yes, please explain:
Summarize any special training, skills, qualifications, licenses and or certifications that may assist you in performing the position for which you are applying:
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Employment History
Starting with your most recent employer, provide the following information.
Employer (1)
Employer Phone
Dates Employed
*
Address
Starting title/final title
*
Immediate Supervisor name
*
May we contact for reference?
*
Yes
No
What is your best guess as to how this supervisor would rate your overall performance?
*
Excellent
Very Good
Good
Fair
Poor
Impossible to Provide
If you are leaving or have left the company, please indicate your motivation to leave.
*
100% Mine
Mutual
100% Company's
Options don't fit circumstance
Why did you leave or why are you leaving?
*
What did you like most about this position?
*
What did you like least about the position?
*
Summarize the type of work performed and job responsibilities
*
Employer (2)
Telephone
Dates employed
Address
Starting title/final title
Immediate Supervisor
May we contact for reference?
Yes
No
What is your best guess as to how this supervisor would rate your overall performance?
Excellent
Very Good
Good
Fair
Poor
Impossible to provide
If you are leaving or have left the company, please indicate your motivation to leave.
100% Mine
Mutual
100% Company's
Options don't fit circumstance
Why did you leave?
What did you like most about the position?
What did you like least about the position?
Summarize the type of work performed and job responsibilities
Employer (3)
Telephone
Dates employed
Address
Starting title/final title
Immediate Supervisor
May we contact for reference?
Yes
No
What is your best guess as to how this supervisor would rate your overall performance?
Excellent
Very Good
Good
Fair
Poor
Impossible to Provide
If you are leaving or have left the company, please indicate your motivation to leave.
100% Mine
Mutual
100% Company's
Options don't fit circumstance
Why did you leave?
What did you like most about the position?
What did you like least about the position?
Summarize the type of work performed and job responsibilities
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Explain any gaps in your employment, other than those due to personal illness, injury or disability.
If not addressed on previous page, have you ever been fired or asked to resign from a job?
*
Yes
No
If Yes, please explain:
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Educational Background
Starting with your most recent school attended, provide the following information.
Rows
School (including City and State)
Years Completed
GPA
Major/Minor
Phone
1
2
3
4
References
List names and telephone numbers of three business/work reference who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Rows
Name
Title
Relationship to you
Telephone
Email
# of Years
1
2
3
4
Related Information
To what job-related organizations (professional, trade, etc.) do you belong? Exclude memberships that would reveal race, color, religion, sex, nation-al origin, genetic information, citizenship, age, mental or physical disabilities, veteran/reserve National Guard or any other similarly protected status.
Rows
Organization
Office Held
1
2
3
4
List special accomplishments, publications, awards, etc. Exclude information that would reveal race, color religion, sex, national origin, genetic information, citizenship, age, mental or physical disabilities, vetern/reserve National Guard or any other similarly protected status.
In your current or a prior job, have you ever written instruction or directions to be followed by employees or customers?
Yes
No
Not Applicable
If Yes, please explain:
Is there any other job-related information you want us to know about you?
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Applicant Statement
I certify that all information I have provided in order to apply for and secure work with this employer is true, complete, and correct.I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, or seeking, gathering and using truthful and non-defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations furnishing such information about me.I understand that this employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or eliminating any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.If I am hired, I understand that I am free to resign at anytime, with or without cause and with or without prior notice, and the employer reserves the same right to terminate my employment at anytime, with or without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer’s president.I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.This company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This company likewise does not tolerate harassment based on sex, race, color, religion, national origin, genetic information, citizenship, age, disability, or any other protected status. Examples of prohibited harassment include, physical contact, offensive gestures, unwelcome comments, jokes, epithets, threats, insults, name calling, negative stereotyping, possession or display of derogatory pictures or other graphic materials, and any other words or conduct that demean, stigmatize, intimidate, or single out a person because of his or her membership in a protected category. Harassment of our employees is strictly prohibited, whether it is committed by a manager, coworker, subordinate, or non-employee (such as a vendor or customer). The company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to eliminate me from further consideration for employment, or may result in my immediate discharge from the employers service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature
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