Application – Lachrisbren Office Cleaning

Lachrisbren Office Cleaning

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Full Name *

Birth Date *

Email *

Address *

Apartment/ Unit #

City/ State

Zipcode/ Postal Code

Home Phone

Cell Phone

Alternative Phone

Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation? *

Yes
No

Are you able to pick up 25 lbs. or more? *

Yes
No

Have you ever used names other than those stated in the first section of this application? If so, please list:

List all states and countries of residence for the past seven years: *

Have you ever been convicted of a crime? *

Yes
No

If yes, please explain:

Do you know any languages besides English?

Yes
No

If yes, please list the languages that you speak and read fluently:

Do you have a Driver's License? *

Yes
No

State of Driver's License Issue: *

Do you have a dependable vehicle? *

Yes
No

Have you had any accidents in the past 3 years? *

Yes
No

If yes, how many?

Have you had any moving violations in the past 3 years?

Yes
No

If yes, how many?

The section below goes over emergency contact information.

Emergency Contact: Full Name *

Emergency Contact: Relationship *

Emergency Contact: Primary Phone *

The section below goes over job avaliability and prior employment information.

When are you available to begin working? *

Hours available to work: Monday

Hours available to work: Tuesday

Hours available to work: Wednesday

Hours available to work: Thursday

Hours available to work: Friday

Hours available to work: Saturday

Hours available to work: Sunday

How many hours can you work, daily?

How did you hear about this position?

(1) Name of Previous Employer: *

(1) Name of Last Supervisor: *

(1) Complete Address: *

(1) Phone: *

(1) Date of Employment- From: *

(1) Date of Employment- To: *

(1) Salary- Starting: *

(1) Salary- Ending: *

(1) Last Job Title: *

(1) Reason for Leaving: (Be Specific) *

(1) List the jobs you held, duties performed, skills used, or learned, advancements, or promotions while you worked at this company: *

(1) May we contact your employer? *

Yes
No

(2) Name of Previous Employer:

(2) Name of Last Supervisor:

(2) Complete Address:

(2) Phone:

(2) Date of Employment- From:

(2) Date of Employment- To:

(2) Salary- Starting:

(2) Salary- Ending:

(2) Last Job Title:

(2) Reason for Leaving: (Be Specific)

(2) List the jobs you held, duties performed, skills used, or learned, advancements, or promotions while you worked at this company:

(2) May we contact your employer?

Yes
No

(3) Name of Previous Employer:

(3) Name of Last Supervisor:

(3) Complete Address:

(3) Phone:

(3) Date of Employment- From:

(3) Date of Employment- To:

(3) Salary- Starting:

(3) Salary- Ending:

(3) Last Job Title:

(3) Reason for Leaving: (Be Specific)

(3) List the jobs you held, duties performed, skills used, or learned, advancements, or promotions while you worked at this company:

(3) May we contact your employer?

Yes
No

Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying: *

The section below goes over education and military service.

Name of High School and Complete Mailing Address: *

No. Years Completed: *

Major or Degree: *

Name of College Bus. or Trade School and Complete Mailing Address:

No. Years Completed:

Major or Degree:

Name of Professional School and Complete Mailing Address:

No. Years Completed:

Major or Degree:

Name of Other School and Complete Mailing Address:

No. Years Completed:

Major or Degree:

Have you ever, (or are you currently) served in the United States Military? *

Yes
No

If yes, What branch of Military, and dates served:

Status of Discharge (or current status):

The section below goes over references.

(1) Reference- Name: *

Please list two (2) references other than relatives and previous employers

(1) Position: *

(1) Company: *

(1) Phone: *

(2) Reference- Name: *

(2) Position: *

(2) Company: *

(2) Phone: *

The section below goes over the 90 day introductory period.

All new Lachrisbren Office Cleaning employees are considered to be in an initial introductory period for the first ninety-(90) DAYS of employment. During this period, the company and the employee will have the opportunity to determine whether further employment with the company is mutually desirable. Nothing about this initial introductory period changes the fact that all employment with the company is "AT WILL" and the employment relationship can be terminated by either the employee or the company at the time during or after the initial introductory period, for any reason, with or without cause. I have read and understand the term of the 90 Days Introductory Period. I agree:

Yes
No

Please confirm the information below.

EMPLOYMENT REQUIREMENTS 1. Able to follow written and verbal instructions. 2. 18 years of age or older. 3. Willing to work alone. Able to work without supervision. 4. Willing to follow a conduct, safety, and dress code. 5. Able to pass drug and physical screens. 6. Have reliable transportation to and from assigned work areas. 7. Able to perform the physical duties of the job which include: - Able to be on feet for several hours - Custodial Applicants: Able to lift and carry 25 pounds frequently; lift 40 pounds occasionally. - Floor Crew Applicants: Have a valid drivers license and good driving record. Able to lift up to 100 pounds, push/pull up to 150 pounds. - Able to bend, squat, climb stairs with a light load, use arms overhead. Job requires regular use of arm, shoulder and wrist joints. - If you have spine or shoulder injuries or soreness, you may not be able to use our backpack vacuums which are sometimes required. - Able to work at a fast pace within a time limit. - Have normal vision or wear corrective lenses for close-up and distance. I have read, understand and meet the employment requirements for the position I have applied for. SIGNATURE Please Read Carefully: I understand that Lachrisbren Office Cleaning will rely upon the information I have provided in this application and during any interview. I certify that I have had sufficient time to carefully fill out this application and the answers given herein are true and complete to the best of my knowledge and that the application does not contain and errors, omissions, misrepresentations, or any information which could be interpreted as misleading. I understand that that any error, misrepresentation, omission, or misleading information in my application or interview(s) will be grounds for termination of employment. I authorize the employees, schools, or persons named above to release to Lachrisbren Office Cleaning all information regarding my employment, character and qualifications, and agree to hold all persons harmless with respect to the information they may give, receive or publish. I understand that nothing contained in this employment application creates contracts between Lachrisbren Office Cleaning and myself for employment or any other benefit. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon Lachrisbren Office Cleaning. If an employment relationship is established, I understand that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either Lachrisbren Office Cleaning or myself. I further understand that no representative of Lachrisbren Office Cleaning, other that the President of the company, has any authorization to enter into any agreement for any employment for any specified period of time, or to make any agreement contrary to the forgoing and any such agreement to the company must be in writing and signed by the president. I also understand that I am required to abide by all of the rules and regulations of the company. I understand that I may be required to disclose criminal convictions at a later time. I hereby consent to undergo a drug urinalysis and/or physical examination by a physician appointed by Lachrisbren Office Cleaning, at Lachrisbren Office Cleaning's expense, should such an examination be requested. Electronic Signature (enter your name):

Confirm Signature:

Phone

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