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:
    Swanzey, 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
    Year Graduated:



    College/Trade School:
    Fields Studied:
    Graduated?
    YesNo
    Year Graduated:



    Other:
    Fields Studied:
    Graduated?
    YesNo
    Year Graduated:



    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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