R & A Cleaning Services Employment Application
Applicant Information
Last Name
First Name
Middle Initial
Date
Street Address
Apartment/Unit#
City
State
Zip
Phone
Email
Date Available
Desired Salary
Position Applied For
Are you a Citizen of the United States?
Yes
No
If no are you authorized to work in the U.S.
Yes
No
Have you ever worked for this company?
yes
no
If yes, when?
Have you ever been convicted of a felony?
yes
no
(Will not necessarily exclude you from consideration)
If yes, explain:
Education
High School
Address
From
To
Did you graduate
yes
no
College
Address
From
To
Did you graduate
yes
no
Other
Address
From
To
Did you graduate
yes
no
References
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Full Name
Relationship
Company
Phone
Address
Previous Employment
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for leaving
May we contact your previous supervisor for a reference?
yes
no
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for leaving
May we contact your previous supervisor for a reference?
yes
no
Company
Phone
Address
Supervisor
Job Title
Starting Salary
Ending Salary
Responsibilities
From
To
Reason for leaving
May we contact your previous supervisor for a reference?
yes
no
Military Service
Branch
From
To
Rank at discharge
Type of Discharge
If other than honorable, explain
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I understand that my Social Security Number, if it exists, must be supplied in person.