(703) 986-3737

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Employment Application

Applicant Information
Applicant Name:
Home Phone:
Other:
Email Address:
Current Address:
Number and street:
City:
State & Zip:
Employment Positions:
Position(s) applying for:
Are you applying for:
Regular full-time work? Yes No
What days and hours are you available for work?
If hired, on what date can you start working?
(enter date. example: 2/1/09)


Personal Information:
Do you have a virginia drivers licence? Yes No
can you supply dmv record? Yes No
how many points do you have on drivers licence?
Have you ever applied to / worked for Company before? Yes No
If yes, please explain (include date):
Do you have any friends, relatives, or acquaintances working for Company? Yes No
If yes, state name & relationship
If hired, would you have transportation to/from work? Yes No
Email address Yes No
(If under 18, hire is subject to verification of minimum legal age.)
If hired, are you willing to submit to and pass a controlled substance test? Yes No
Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No
If yes, please describe the crime - state nature of the crime(s), when and where convicted and disposition of the case:

Education, Training and Experience
High School:  
School name:
School city, state, zip:
Did you graduate? Yes No
Degree / diploma earned:
College / University:
School name:
School city, state, zip:
Did you graduate? Yes No
Degree / diploma earned:
Vocational School:
Name:
City, state, zip:
Did you graduate? Yes No
Degree / diploma?
Military:  
Branch:
Rank in Military:
Total Years of Service:
Skills/duties:
Related details:
Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?
Yes No
If yes, please explain:


Employment History
Are you currently employed? Yes No
If you are currently employed, may we contact your current employer? Yes No
Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. This section must be completed.
Name of Employer:
Name of Supervisor:
Telephone Number
Business Type:
Address:
City, state, zip:
Length of Employment: (Include Dates)
Position & Duties
Reason for Leaving
May we contact this employer for references? Yes No
   
Name of Employer:
Name of Supervisor:
Telephone Number
Business Type:
Address:
City, state, zip:
Length of Employment: (Include Dates)
Position & Duties
Reason for Leaving
May we contact this employer for references? Yes No

References
List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.
Name - First, Last:
Telephone Number
Address:
City, state, zip:
Occupation:
Number of Years Acquainted:
  .
Name - First, Last:
Telephone Number
Address:
City, state, zip:
Occupation:
Number of Years Acquainted:
   
Name - First, Last:
Telephone Number
Address:
City, state, zip:
Occupation:
Number of Years Acquainted:


I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability.

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.

I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
Applicant's name:
Date:

 

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no1ductcleaner.com

2988 P.S. Business Center
Woodbridge, VA 22192

Phone: (703)  986-3737
Fax: (703)  652-7675

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