POSITION APPLIED FOR

Position Title

Location

Date

Personal Information

Name (Last, First, Middle Initial)

Address (Street, City, State, Zip Code)

Home Telephone Number

Work Telephone Number

How did you find out this job opening?

Web Page (identify)
Newspaper/Journal Ad (identify)
Referral
Job Service/ESC
Other (Please Explain)

Are you authorized to work in the U.S.?

Yes
No

If employed, you must show documents that prove your identity and employment eligibility as required by the Immigration Reform and Control Act of 1986.

Do you require sponsorship?

Yes
No

Have you ever been convicted of a felony?

Yes
No

If yes, explain.

A conviction will not automatically remove you from consideration for employment.

EDUCATION

High School

Did You Graduate?

Yes
No

High School

College or University

High School

Did You Graduate?

Yes
No

High School

Other

High School

Did You Graduate?

Yes
No

High School

EMPLOYMENT HISTORY

List all employment including military starting with the most current position held. Show employment history for at least 10 years. Explain gaps in employment history. You may attach a résumé, but you must complete the employment section. This information will be used in reference checks. Failure to answer all items in the following section may eliminate you from further consideration.

Dates Employed (month/year)

From To

Position Title

Salary Start: $

Salary Final: $

Company Name/Address

Full Time
Part-time, hrs/wk

Supervisor’s Name/Title

Supervisor's Telephone Number

Reason For Leaving:

Duties:

Dates Employed (month/year)

From To

Position Title

Salary Start: $

Salary Final: $

Company Name/Address

Full Time
Part-time, hrs/wk

Supervisor’s Name/Title

Supervisor's Telephone Number

Reason For Leaving:

Duties:

Dates Employed (month/year)

From To

Position Title

Salary Start: $

Salary Final: $

Company Name/Address

Full Time
Part-time, hrs/wk

Supervisor’s Name/Title

Supervisor's Telephone Number

Reason For Leaving:

Duties:

REFERENCES (Do not list relatives.)

Name

Address

Telephone Number

Name

Address

Telephone Number

Name

Address

Telephone Number

DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge. I understand that this employment application is not a contract for employment. I understand that employment is “at-will” and that either GrimeGuru or I can terminate the employment relationship without reason and without advance notice. Further, I understand that any false, deliberately misleading information, or material omissions on this employment application will eliminate me from consideration for employment, or if I’m hired, will result in my termination.

In addition, I understand that both a drug test and a background check may be a part of the hiring procedure. Finally, I understand that any offer of employment will be withdrawn if my drug test results are positive.

SIGNATURE

Date

Careers

We have job openings available!

POSITION APPLIED FOR

Personal Information

EDUCATION

EMPLOYMENT HISTORY

REFERENCES (Do not list relatives.)

Hours of Operation

Careers

We have job openings available!

POSITION APPLIED FOR

Personal Information

EDUCATION

EMPLOYMENT HISTORY

REFERENCES (Do not list relatives.)

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