Clean Supreme Employment Application

CLEAN SUPREME LLC

info@cleansupremellc.com | www.cleansupremellc.com
Job Application

Please complete the form below to apply for a position with us.
Full Name*

First Name Middle Name Last Name
Current Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Email Address*
Social Security Number*
xxxxxxxxx
Phone Number*

Area Code Phone Number
Applying for Position*
Position City*
Applying for Position*
Hourly Wage desired?
Have you ever been convicted of a felony, or a misdemeanor involving any violent act, drugs, use or possession of a weapon, or act of dishonesty for which the record has not bee sealed or expunged, or do you have such a case pending?*

YesNo
If Yes, when and where?
Start date*

MonthDay Year
Are you 18 years of age or older?*

YesNo
If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by Federal Law.
Name of High School Attended
School Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Graduate?
GED?
Name of College Technical School
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Graduate?
Degree?
List any job related skills or accomplishments, including military service

Your availability For work

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
From:
To:

Give three references that are not former employers who we may contact

	Name and Occupation	How Do you know them and for how long	Phone Number
Reference 1
Reference 2
Reference 3

Type a question

CLEAN SUPREME, LLC BACKGROUND CHECK AUTHORIZATION FORM
This information is provided solely for the purpose of conducting a background check.
Name*

First Name Middle Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of Birth*

MonthDay Year
Date
Social Security Number*
Driver's License Number*
Driver's License State*
Race
Gender

MaleFemale
Other or Former Names*
I have read and understand the above statements.

I affirm the above statements to be true.
Signature*

Clear
Date*

MonthDay Year
Date
For I9 verification, please upload your photo ID

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Please upload a photo of your social security card.

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Job Application