Job Application | Laundry Clinic

Name

First

Last

Address

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code Country

Email

Phone*

Driver’s License Number

Expiration Date

State

Can you verify your legal rights to work in the United States by providing a birth certificate, proof of U.S. Citizenship, or by some other means? *

Yes

No

Are you a Smoker?

Yes

No

Have you been or convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses, which has not been annulled, expunged, or sealed by a court? (A conviction record will not necessarily be a bar to employment.)*

Yes

No

If “yes”, please describe in full detail:

How many hours per week can you work? *

EDUCATION AND TRAINING

Education

Name and Location of School

Course of Study

No. Years Completed

Did You Graduate?(Y/ N)

High School

Trade or Business

College

Describe any special qualifications, skills, or other relevant training you have: ie cash register, computer, bi-lingual,

Why are you the best applicant for this job?

In the space provided below give your employment history for the last 10 years, beginning with your PRESENT or most recent employer. List all positions held, including military, part-time, summer and volunteer work. Applications without accurate phone numbers for previous employers will not be reviewed. Details on any period of unemployment must be included.

EMPLOYMENT HISTORY

EMPLOYER

ADDRESS

TELEPHONE NO

SUPERVISOR

MAY WE CONTACT? YES OR NO

START DATE

END DATE

STARTING SALARY

ENDING SALARY

REASON FOR LEAVING

JOB TITLE:

DUTIES PERFORMED

Employer 1

Employer 2

Employer 3

Employer 4

Why do you want to work here?

Which previous job was your favorite and why?

What goals are you working towards?

CERTIFICATION and ACKNOWLEDGEMENT: I certify that the information in my application for employment is true and complete to the best of my knowledge. I understand that any incorrect, incomplete, exaggerated or false information furnished by me will subject me to disqualification or to discharge from employment at any time. Further, I understand and acknowledge that any employment relationship with Laundry Clinic is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge the employee at any time with or without cause or notice. I further understand that this “at will” employment relationship may not be changed by any expressed or implied contract.

AUTHORIZATION: I authorize my former employers and character references to release any information regarding my employment. I hereby authorize laundry Clinic to make any investigation of my background as is deemed necessary to verify my qualifications for the position for which I am applying.

Applicant Signature ( your full name)*

Today's Date*