Application For Employment

Personal Information:

First Name:
Middle:
Last Name:


Address:
City:
State:
Zip:


Phone:
Cell Phone:
Email:



Pre-Employment:

Are you willing to submit to a drug screening?
YesNo


Are you willing to submit to a background check?
YesNo


Do you give Cheshire Cleaning permission to check your references?
YesNo



Employment Information:

Position for which you are applying:
Part-timeFull-time


Location for which you are applying:
Bennington, VTKeene, NH


Check off box with days of week you are available (PT/FT)
SundayMondayTuesdayWednesdayThursdayFriday
Cheshire Cleaning, Inc. hours of operation are from 3:00 pm -2:00 am, 7 days/week.


If offered this position, when are you available to report for work?

For Browsers that do not support this function please input the date in this YYYY-MM-DD formating (e.g. 2013-04-08).


Are you currently employed? If yes, please complete the information below.
YesNo


Employer's Name


Present Salary?


May we contact this employer for a reference?
YesNo


If yes, phone:


If no, why?


If hired can you show proof of you legal right to work in the USA?

YesNo


Have you ever been dismissed or asked to resign from any position?

YesNo


Have you ever been convicted of a felony or a misdemeanor which has resulted in imprisonment?
A yes answer to the above question does not necessarily disqualify an applicant from employment.

YesNo


If yes to the last 2 questions, please explain:

Employment Experience (List most Recent first):

Name:
Address:
Position(s) Held:
Dates (Start-End):



Name:
Address:
Position(s) Held:
Dates (Start-End):



Name:
Address:
Position(s) Held:
Dates (Start-End):



Name:
Address:
Position(s) Held:
Dates (Start-End):




References:

Name:
Address:
Phone:
Relationship:

Name:
Address:
Phone:
Relationship:

Name:
Address:
Phone:
Relationship:

Name:
Address:
Phone:
Relationship:




Education:

High School:
Fields Studied:
Graduated?
YesNo



College/Trade School:
Fields Studied:
Graduated?
YesNo



Other:
Fields Studied:
Graduated?
YesNo



I certify that all statements made herein and on the enclosed resume are true and correct to the best of my knowledge. I authorise investigation of all statements herein recorded. I release from liability all persons and organizations reporting information required by this application.



Signature

Date
For Browsers that do not support this function please input the date in this YYYY-MM-DD formating (e.g. 2013-04-08)

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