APPLY HERE



P.O. Box 2818   •   Holland, Michigan 49422-2818

AN EQUAL OPPORTUNITY EMPLOYER

APPLICATION FOR EMPLOYMENT

(PRE-EMPLOYMENT QUESTIONNAIRE)



PERSONAL INFORMATION

Yes   No


JOB INFORMATION

Position Desired
Area I Wish To Work
Please check the shift(s) you are available First    Second    Third    Weekends   
Please check the days/nights available Sunday     Monday    Third    Wednesday    Thursday    Friday    Saturday   
PLEASE SELECT ONE Regular Full-Time    Temporary Full-Time    Regular Part-Time    Temporary Part-Time   
Select Maximum number of hours desired per shift Maximum days desired per week
Maximum hours per week If hired, how soon after notification could you start?
Wage Desired $
If applying for a cleaning position, do you have any commercial cleaning experience? No    Yes   
If yes, When? Where?
Have you previously worked for Enviro-Clean? No    Yes   
If yes, When?     Where?    
Under what name?


EDUCATION (list all schools attended)

 

Name and Address

Yrs. Attended

Graduated

Subjects Studied
High Schools/ Tech. School.

Yes No
Colleges/ Universities

Yes No
Other Ed./ Training

Yes No


CRIMINAL BACKGROUND

Have you ever been CONVICTED of a crime, other than a traffic violation? Yes   No
If yes, explain conviction(s) When? Where?
Are there any criminal charges pending against you?

(A conviction record will not necessarily be a bar to employment.)		 Yes    No Please explain any "Yes" answer.
Are you legally eligible to work in the U.S.A.? (Verification will be required upon hire.) Yes    No


FORMER EMPLOYERS

Please list the last four employers starting with current one first)

#1: Insert employment information


Employer: From:   To:     Salary:
Address: Position & Duties:
Supervisor: Reason for leaving:

#2: Insert employment information


Employer: From:   To:     Salary:
Address: Position & Duties:
Supervisor: Reason for leaving:

#3: Insert employment information


Employer: From:   To:     Salary:
Address: Position & Duties:
Supervisor: Reason for leaving:

#1: Insert employment information


Employer: From:   To:     Salary:
Address: Position & Duties:
Supervisor: Reason for leaving:


IN CASE OF EMERGENCY, NOTIFY:

Name    
Address    
Phone    



"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND AND AGREE THAT FALSIFICATION, MISREPRESENTATION OR OMISSION OF FACT EITHER ON THIS APPLICATION OR DURING THE PRE-HIRE PROCESS WILL BE REASON FOR(l) NOT BEING OFFERED EMPLOYMENT OR (2) DISMISSAL AT ANY TIME FROM THE SERVICE OF THE COMPANY, IF EMPLOYED.


I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN (INCLUDING RELEASE OF ANY POLICY RECORDS) AND THE REFERENCES LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.


I UNDERSTAND AND AGREE, IF HIRED, MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME BY THE COMPANY, WITH OR WITHOUT CAUSE, AND WITHOUT ANY PRIOR NOTICE. THIS PROVISION SUPERSEDES ANY ORAL OR WRITTEN REPRESENTATIONS TO THE CONTRARY, UNLESS THE WRITTEN STATEMENT IS SIGNED BY THE PRESIDENT OF THE COMPANY."