Combat Cleanerz Employment Application

First Name: * *required.

Last Name: * *required.

Date of Birth - mm/dd/yy - * A value is required..

Social Security Number *A value is required.Invalid format.

Do you have a permanent address? Y/N *A value is required.

City: *A value is required.

State : * A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

How long have you lived at this address? *A value is required.

Do you plan on staying in the area for more than 1 year? Y/N * A value is required.

Have you ever applied for a job with this company before? * A value is required.

What hourly rate are you looking for? * A value is required.

How many hours do you need per week? *A value is required.

How did you hear about Combat Cleanerz? Online Ad Friend Website Newsletter A Combat Cleaner Please select an item.

What is your mailing address ? * A value is required.

Mailing City: *A value is required.

Mailing State: *A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

Mailing Zip Code: * A value is required.Invalid format.

Email Address: * A value is required.Invalid format.

When is the best time to call you? *A value is required.

May we call you at work? Y/N * A value is required.

Telephone Number 1: *A value is required.Invalid format. Type: cell home work Please select an item.

Telephone Number 2: *A value is required.Invalid format. Type cell home work Please select an item.

Driver's License Number: *A value is required.

Driver's License State * A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

Driver's License Expiration Date: mm/dd/yy *A value is required.Invalid format.

Whom shall we contact in the case of an emergency? * A value is required.

What is their phone number? *A value is required.Invalid format.

Do you have all the information to complete Form I-9? *A value is required.

Do you have a reliable car? * A value is required.

Are you able to work mid-afternoon and
evening hours as well as the weekends? * A value is required.

If need be, please explain your availability:
A value is required.

Please detail any management experience you have had:
A value is required.

Name, City and State of your High School: * A value is required.

Did you graduate? Y/N * A value is required.

Do you have your GED? * A value is required.

Name, City and State of College: A value is required.

Major: A value is required.

Do you have your degree? A value is required.

Semester hours completed: A value is required.

Concentration: A value is required.

Name, City and State of Trade School: A value is required.

Did you complete your training? Y/N A value is required.

What trade did you study? A value is required.

Do you have any experience cleaning commercial buildings? Y/N A value is required.

Please list your expereince:
A value is required.

Do you have experience cleaning carpets? Y/N A value is required.

Do you know about floor maintenance? Y/N A value is required.

Do you have any experience being a supervisor in a service business? Y/N A value is required.

Please detail your experience:
A value is required.

Thank you for your patience. Now we need know some things about where you used to work and some details about any criminal history that you might have.

Remember that required fields "*" MUST be filled out. Stick with it. You're almost done!

Name of Employer # 1 * A value is required.

Type of Business: * A value is required.

Address: * A value is required.

City: * A value is required.

State: A value is required.* A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

Zip Code: * A value is required.Invalid format.

Phone #: *A value is required.Invalid format.

When did you start? mm/dd/yy * A value is required.Invalid format.

When did you leave? mm/dd/yy * A value is required.Invalid format.

Starting wage: ($00.00) /hr * A value is required. Ending wage: ($00.00) /hr * A value is required.

Full time or Part time? * A value is required.

Name and Title of Supervisor: * A value is required.

May we contact them? Y/N * A value is required.

Please list the job's duties: *
A value is required.

Why did you leave?*
A value is required.

Name of Employer #2: * A value is required.

Type of Business: * A value is required.

Address * A value is required.

City: *A value is required.

State: * A value is required. A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

Zip Code: * A value is required.Invalid format.

Phone: * A value is required.Invalid format.

When did you start? mm/dd/yy *A value is required.Invalid format. When did you leave? mm/dd/yy * A value is required.Invalid format.

Starting Wage: ($00.00) /hr * A value is required. Ending Wage: ($00.00) /hr A value is required.*

Full or Part time? * A value is required.

Name and Title of Supervisor: * A value is required.

May we contact them? Y/N * A value is required.

Please list the job's duties:*
A value is required.

Why did you leave? *
A value is required.

Name of Employer #3: * A value is required.

Type of Business: * A value is required.

Address: * A value is required.

City: * A value is required.

State: * A value is required. A value is required. example- please enter "PA" if your mailing state is Pennsylvania.

Zip Code * A value is required.Invalid format.

Phone #: * A value is required.Invalid format.

When did you start? mm/dd/yy * A value is required.Invalid format. When did you leave? mm/dd/yy * A value is required.Invalid format.

Starting wage: ($00.00) / hr * A value is required. Ending wage: ($00.00) A value is required.*

Full time or Part time? A value is required.*

Name and Title of Supervisor: *A value is required.

May we contact them? Y/N A value is required.*

Please list the job's duties: *

A value is required.

Why did you leave?*
A value is required.

Have you ever pleaded guilty, no contest to, or have been convicted of a felony or a lesser crime which involved theft, dishonesty or violence in the past 7 years? Y/N * A value is required.

If so, please describe the nature of the offense(s) and the county and state where convicted: * A value is required.

Have you had your driver's license suspended or revoked in the past 5 years? Y/N A value is required.*

Please describe the incident: *
A value is required.

Have you ever been disciplined or fired by and employer in the past 5 years? Y/N * A value is required.

If so, please explain: *
A value is required.

I hereby authorize COMBAT CLEANERZ to investigate all statements made within this application, reviewing my driving and criminal records as well as the option to contact my previous employers. I understand that any false statements(s) made herein may eliminate my application from employment consideration or if discovered after hire, may result in my discharge from employment with Combat Cleanerz.

If hired, I will conform to the policies, rules and regulations of Combat Cleanerz.

If asked, I agree to submit to drug testing and I also agree to sign the "Non-Compete" agreement. I acknowledge that both my employment and my compensation can be terminated or changed at will, without prior notice and at the sole option of Combat Cleanerz.

Check the box if you have fully read and understood the above statements .*

Applicants Signature: *

Date: mm/dd/yy *

Click the button and you're all done!