LESLIE'S CLEANING SERVICE

PERSONAL INFORMATION

NAME:

FIRST *

MIDDLE *

LAST *

CURRENT ADDRESS:

STREET *

CITY *

STATE *

ZIP *

E-MAIL ADDRESS: *

PHONE NUMBER: *

ARE YOU 18 YEARS OR OLDER? *

Please select at least one option.

Yes No

IN CASE OF EMERGENCY

Name *

Address *

Phone *

EMPLOYMENT INFORMATION

POSITION DESIRED *

DATE YOU CAN START *

DESIRED PAY *

Please select at least one option.

ARE YOU EMPLOYED NOW? *
Yes No

Please select at least one option.

IF SO MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? *
Yes No

Please select at least one option.

EVER APPLIED TO THIS BUSINESS BEFORE? *
Yes No

Please select at least one option.

EVER WORKED FOR THIS BUSINESS BEFORE? *
Yes No

EDUCATION

GRAMMER:

NAME AND LOCATION

# OF YEARS ATTENDED

Please select at least one option.

DID YOU GRADUATE
Yes No

HIGH SCHOOL:

NAME AND LOCATION

# OF YEARS ATTENDED

Please select at least one option.

DID YOU GRADUATE
Yes No

COLLEGE:

NAME AND LOCATION

# OF YEARS ATTENDED

Please select at least one option.

DID YOU GRADUATE
Yes No

FORMER EMPLOYERS (LIST BELOW LAST THREE EMPLOYERS STARTING WITH LAST ONE FIRST)

FROM :

TO :

NAME AND ADDRESS OF EMPLOYER

POSITION

PAY

REASON FOR LEAVING

FROM :

TO :

NAME AND ADDRESS OF EMPLOYER

POSITION

PAY

REASON FOR LEAVING

FROM :

TO :

NAME AND ADDRESS
OF EMPLOYER

POSITION

PAY

REASON
FOR LEAVING

REFERENCE (GIVE THREE PERSONS WHOM YOU HAVE WORKED FOR AT LEAST ONE YEAR)

NAME

PHONE #

BUSINESS

# OF YEARS ACQUAINTED

NAME

PHONE #

BUSINESS

# OF YEARS ACQUAINTED

NAME

PHONE #

BUSINESS

# OF YEARS ACQUAINTED

IMPORTANT

PLEASE READ CAREFULLY!!

NOTICE TO ALL APPLICANTS

WE CONSIDER APPLICANTS FOR EMPLOYMENT WITHOUT REGARD TO AN INDIVIDUAL’S RACE, COLOR, RELIGION/CREED, SEX, NATIONAL ORGIN, AGE, VETERAN STATUS, CITIZENSHIP, HANDICAP/DISABILITY OR OTHER CLASSIFICATION PROTECTED BY LAW.

IT IS THE POLICY OF LESLIE’S CLEANING SERVICE TO PROHIBIT THE POSSESION, DISTRIBUTION, TRANSPORTATION, CONCEALMENT OR USE OF ANY ILLEGAL OR UNAUTHORIZED ITEMS INCLUDING BUT NOT LIMITED TO: DRUGS, DRUG PARAPHERNALIA, “LOOK ALIKES”, OTHER CONTROLLED SUBSTANCES NOT SPECIFICALLY PRESCRIBED TO YOU, ALCOHOLIC BEVERAGES, TOBACCO, WEPONS, AMMUNATION, EXPLOSIVES, OR STOLEN PROPERTY WHILE ENTERING, BEING ON OR LEAVING ANY COMPANY PREMISE, WORK AREA, WORK LOCATION, OR AT ANY OTHER TIME DURING THE COURSE OF YOUR EMPLOYMENT.

THE FOLLOWING PRE-EMPLOYMENT TESTS ARE REQUIRED BEFORE ANY OFFER FOR EMPLOYMENT IS MADE:

SCREENING FOR ILLEGAL DRUGS
BACKGROUND CHECK
ELITE CHARACTER PROFILE
CUSTOM LESLIES CLEANING SERVICE EVALUATION

WITH MY SIGNATURE I CONFIRM THAT I HAVE READ, UNDERSTOOD, AND ABLE TO PERFOM AND ABIDE BY THE JOB REQUIREMNTS SET FORTH BY LESLIE’S CLEANING SERVICE.

WITH MY SIGNATURE, I AUTHORIZE LESLIE’S CLEANING SERVICE OR ITS DESIGNATED REPRESENTATIVE TO MAKE ANY INVESTIGATION OF PERSONAL HISTORY AND EMPLOYMENT RECORDS THROUGH ANY INVESTIGATIVE AGENCIES OR BUREAUS OF ITS CHOICE WITHOUT LIABILITY FOR NEGLIGENCE OR OTHERWISE. I ALSO WAIVE ANY CLAIM AGAINST ANY INDIVIDUAL OR COMPANY WHICH SUPPLIES THE COMPANY WITH INFORMATION.

WITH MY SIGNATURE, I CONFRIM THAT ALL OF MY ANSWERS TO THE ABOVE QUESTIONS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT ANY MIS-STATEMENT OF MATERIAL FACT IN THIS APPLICATION WILL, UPON DISCOVERY, CAUSE MY APPICATION, CONDITIONAL OFFER OF EMPLOYMENT OR EMPLOYMENT WITH LESLIE’S CLEANING SERVICE TO BE TERMINATED. WITH MY SIGNATURE I CONFIRM THAT I UNDERSTAND AND AGREE THAT IF ACCEPTED FOR EMPLOYMENT, THE EMPLOYMENT REALATIONSHIP WILL BE AN EMPLOYMENT-AT-WILL, I.E., MY EMPLOYMENT IS NOT FOR A DEFINITE TERM, AND MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME, A THE OPTION OF EITHER THE COMPANY OR MYSELF. FURTHER, EXCEPT FOR A WRITTEN AGREEMENT ENTERED INTO BY THE PRESIDENT. NO AGENT OR REPRESENTATIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING.

AFTER 30 DAYS YOUR APPLICATION WILL BE CONSIDERED STALE AND, IF STILL INTERESTED IN A JOB, YOU SHOULD REAPPLY.

NAME *

SIGNATURE *

Brief Statement: This is applicant’s opportunity to give a brief statement or introduction of themselves for the purpose of standing out among other applications.

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