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Deer Park Cleaning IncPassionate About Cleaning

Employment Application

Personal Information
Date
First Name
Middle Name
Last Name
Street Address
City, State, Zip
County
Email
Home Phone
Work Phone
Cell Phone
Position Applying For
Full-time or Part-time?
Date you can start
(MM-DD-YYYY)
Nights available M   T   W   TH   F   SAT   SUN
Available at 5:00pm?
Available at 6:00pm?
Salary Desired $ per/hr
Have you ever worked for Deer Park Cleaning before?
If yes, when?
Are you currently employed?
Are you legally eligible for employment in the U.S.?
Do you have your own reliable transportation?
If yes, do you have a valid Driver's License?
Have you ever been convicted of a crime in the past ten years, excluding summary offenses, which have not been annulled, expunged, or sealed by a court? (Conviction is not an automatic bar to employment)
If yes, please describe
 

Emergency
Person to contact in case of emergency
Home Phone
Work Phone
Cell Phone
 

Education

Education Level

(Check last level completed)

Elem./Middle School

High School: 9 10 11 12

High School Graduate GED?

College: 1 2 3 4

Degree:

Trade/Business School:
Applicable Skills/Training
 

References

Below give the names of 3 persons you are not related to, whom you have known at least one year.

Name Relationship Phone #Years Known

Previous Employer
Name of Present or Last Employer
Street Address
City, State, Zip
Starting and Leaving Date (MM/DD/YYYY) -
Job Title
Weekly Starting Salary $
Weeking Final Salary $
May We Contact Supervisor?
Name of Supervisor
Title
Phone
Description of Work
Reason for Leaving
Add Another Employer

Previous Employer #2
Name of Present or Last Employer
Street Address
City, State, Zip
Starting and Leaving Date (MM/DD/YYYY) -
Job Title
Weekly Starting Salary $
Weeking Final Salary $
May We Contact Supervisor?
Name of Supervisor
Title
Phone
Description of Work
Reason for Leaving
Add Another Employer

Previous Employer #3
Name of Present or Last Employer
Street Address
City, State, Zip
Starting and Leaving Date (MM/DD/YYYY) -
Job Title
Weekly Starting Salary $
Weeking Final Salary $
May We Contact Supervisor?
Name of Supervisor
Title
Phone
Description of Work
Reason for Leaving

Deer Park Cleaning, Inc. is an equal opportunity employer and does not discriminate on the basis of race, color, creed, sex, national origin, age, marital or veteran status, or disability.

Applicant's Agreement and Certification - Read Carefully

  1. All information on this application for employment is true and correct. I give Deer Park Cleaning, Inc. permission to check all references and previous employment and educational information and to it's request. I release and hold all persons harmless from liability or damages on account of having furnished, received, or used such information.
  2. I understand and agree that, if hired, my employment by Deer Park Cleaning, Inc. is employment at will and that both Deer Park Cleaning, Inc. and I are free to terminate the employment relationship at no supervisor is authorized to alter the employment at will relationship.
  3. Under Virginia law, an employer may not request or demand any applicant for employment or test or examination as a condition of any employee to submit to or take a polygraph, lie detector, or similar test or examination as a condition of employment or continued employment. Any employer who violates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100.00.

Did you read and agree to the information above.