Application for Employment
General Information
Last name First name
Address
Street Apt. City Province/State Postal Code
Tel. Cell.
Are you legally eligible to accept employment in U.S.A? Yes No
Would you accept employment anywhere in Dade or Broward? Yes No
When are you available to start work?
Driver’s License number if applicable to position:
Do you have transportation to and from job site? Yes No
Social Security #:
Education
| High School / College / University | Did you graduate? | Discipline or Program (Major) | Degree/Diploma/Certificate | Date obtained or expected |
Have you ever pled “guilty,” “no contest,” or been convicted of a crime? If yes, give dates and details:
Answering “yes” to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.
| Dates of Employment | Company Name | Position(s) Held | Supervisor | Starting Salary & Title | Reason for Leaving |
Please furnish the names, addresses and telephone numbers of two people to whom you are not related:
| Name | Phone | Address | City | State |
I certify that my answers are true and complete to the best of my knowledge.
I authorize H&A Janitorial Services Corp. to make such investigations and
inquiries of my personal, employment, educational, financial, or medical
history and other related matters as may be necessary for an employment
decision. I hereby release employers, schools or persons from all liability
when responding to inquiries in connection with my application.
In the event I am employed, I understand that false or misleading information given in my application or interview {s} may result in discharge.