Employment Application Step 1 of 520%Please fill in your first and last name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Mobile Phone NumberEmail address* Are you at least 18 years of age?* Yes NoWhat Date Are You Available to Start?* MM slash DD slash YYYY What is your minimum wage requirement?*Are you capable of listing 25lbs or more?* Yes NoList 3 things that are important in your work environment.* List 3 characteristics that best describe you.* Why do you want to work at Upper Valley Cleaning?*Please list any classes or workshops that pertain to the field.*Please list any special interests, hobbies, and skills.*Additional information you would like us to know about your values, desires, and work ethic:*Are you taking any medication or have any medical conditions that could impact your safety or the safety of others while on the job?* Yes NoPlease check the box below acknowledging that you understand our drug policy.* I understand that Upper Valley Cleaning, LLC is a DRUG FREE & TOBACCO-FREE FACILITY AND WORK PLACE.Do you have a valid driver's license?* Yes NoWhat state was your driver's license issued from?*Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes NoHas any license, permit or privelege ever been suspended or revoked?* Yes NoHave you been involved in a traffic accident in the past 5 years?* Yes NoHave you had any traffic convictions and/or forfeitures in the past 5 years (other than parking violations)?*LocationDateChargesPenalty Have you ever been convicted of a felony or misdemeanor?* Yes NoWe run a complete background check before hiring all employees.If yes, what were you convicted of?Are you able to stand for 2-3 hours at a time?* Yes NoThis position may require that you are on your feet for extended periods of time.Employer 1 InformationMost recent employer.Employer Name*Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone Number*How did you end your employment with this company?* I resigned I was terminated I am currently still employed I am a seasonal employeeJob Title*Starting Pay*Ending Pay*Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Describe your duties at this job.*Supervisor's name?*Supervisor's phone number?*Do we have permission to contact this person as a reference?* Yes NoEmployer 2 InformationEmployer Name*Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer Phone Number*How did you end your employment with this company?* I resigned I was terminated I am currently still employed I am a seasonal employeeJob Title*Starting Pay*Ending Pay*Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Describe your duties at this job.*Supervisor's name?*Supervisor's phone number?*Do we have permission to contact this person as a reference?* Yes NoEducationHigh School(s)*Did you graduate from High School?* Yes No I got my GEDDid you attend any college or university?* Yes NoSignature/Disclosure SectionThe facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my background. A criminal record or sentience is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit to a medical evaluation if required. In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by the company, I hereby release and forever discharge the company (including its directors, officers, employees and agents) and my past and/or present employers (their directors, officers, employees and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize persons to answer all questions asked concerning my ability, character, reputation and previous employment record. I understand that if my application is accepted that employment with this company at all times is employment "at will”. It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my “at will” employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first two weeks with Upper Valley Cleaning, LLC is considered a trial period and that my official start date will be after this period. In the third week of work with Upper Valley Cleaning, LLC., I will have a review with the co-owners to determine any improvements to my performance deemed necessary, my rate of pay, and anything else a manager. I further understand that the first ninety (90) days of employment is a new hire introductory period.* I understand and acknowledge that what I have submitted it true and complete. I agree and understand the terms of employement at Upper Valley Cleaning, LLC.Signature*I understand that by agreeing to the above terms and typing my name here that this is my digital signature.CAPTCHANameThis field is for validation purposes and should be left unchanged.
