Request for Information

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Employment Opportunities

 

Request for Information

Please complete the following form and click Submit, or you may click here and print or download the application.

Position applied for
 Social Security
First Name *
 Last Name *
 Middle
Street Address
 City
State
 		Zip Code
E-mail Address *
Home Phone
 Business Phone
EDUCATION
Check Highest Grade Completed
1    2    3    4    5    6    7    8    9    10    11    12   
Year Completed
If you did not complete high school,
do you have a high school equivalency diploma?
Yes    No   
Date Received
Check number of years of post high school education
1    2    3    4    5    6    7   
EXPERIENCE
May we contact your current supervisor?
Yes   
No   
A. Job Title
 Employer
Address(Street, City, State.)
 Phone
Type of business
 Immediate Supervisor
Title
Salary(Start)
 Salary(end)
Dates of Employment - (month/year to month/year)
Full or Part time?
 		Hours/Week
Number and titles of employees you supervised
 Equipment Used
Reason for leaving
 Your name if different from present
Duties
B. Job Title
 Employer
Address(Street, City, State.)
 Phone
Type of business
 Immediate Supervisor
Title
Salary(Start)
 Salary(end)
Dates of Employment - (month/year to month/year)
Full or Part time?
 		Hours/Week
Number and titles of employees you supervised
 Equipment Used
Reason for leaving
 Your name if different from present
Duties
C. Job Title
 Employer
Address(Street, City, State.)
 Phone
Type of business
 Immediate Supervisor
Title
Salary(Start)
 Salary(end)
Dates of Employment - (month/year to month/year)
Full or Part time?
 		Hours/Week
Number and titles of employees you supervised
 Equipment Used
Reason for leaving
 Your name if different from present
Duties
Use this space for any additional information you think would help us evaluate your application, including training, seminars, workshops,
References
List names, addresses and relationships of three persons not related to you who know your qualifications:
Miscellaneous
Check all requested work times
Day   
Night   
Weekends   
Are you able to provide your own transportation for your employment?
Yes   
No   
Have you ever been convicted for any violation(s) of law? *
Including moving traffic violations
Yes   
No   
If Yes, please provide a description of offense
State of ordinance(if known)
 Date of charge:
(mo/day/yr)
 Date of conviction:
(mo/day/yr)
County, City, State of conviction:
Availability
When will you be able to start work? (No date is necessary if you are available as soon as you give two (2) weeks notice.)

CERTIFICATION

By entering your name and date below,

I hereby certify that all information provided is true and complete, and I agree and understand that any falsification of information herein, regardless of  time of discovery, may cause forfeiture on my part to any employment in the service of Precision  Office Cleaning.  I understand that all information on this application is subject to verification and I consent to criminal history background checks.  I also consent to references and former employers listed being contacted regarding this application.
Date
 Applicant Signature
(Full Legal Name)

* Required to submit this form





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