Employment Application

Meyer's Cleaning Online Employment Application - Part 1
Basic Information
Full Name
*
Present Address
*
Apt. #
City
*
State
*
Zip
*
Email Address
*
Are 18 or older?
 Yes No *


Contact Information
Home Phone
Work Phone
Cell Phone


Misc. Information (Optional)
Date of Birth
Month: Day: Year:
Marital Status
Meyer's Cleaning Online Employment Application - Part 2
Employment
Information*
Desired Employment Position
Date You Can Start?
Expected Hourly Wage:
Employed Currently?
 Yes No If so, can we contact your current employer?:  Yes No
Who Referred You To Us?
How many hours a week are you interested in if available?
Availability - Can You Work:
Early Mornings (5-6am)?  Yes No Daytime?  Yes No
Evenings after 5pm?  Yes No Saturdays?  Yes No
Education*
School Level
Name And Location
# of years
Graduate?
Subjects Studied
Grammar
 Yes
High School
 Yes
College
 Yes
Trade, Business or Other
 Yes
Other Education
Subjects of Special Study or Research Work
Special Training
Special Skills
Meyer's Cleaning Online Employment Application - Part 3
Present
Employer (or last) *
Employer
Name
Present Address
City
State
Zip
Starting Date
Leaving Date
Job Title
Weekly Starting
Salary
/ week
Weekly Final
Salary
/ week
May We Contact
Your Supervisor?
 Yes No
Name of Supervisor
Title of Supervisor
Phone
Description
of Work
Reason for Leaving
Previous Employer
Employer
Name
Present Address
City
State
Zip
Starting Date
Leaving Date
Job Title
Weekly Starting
Salary
/ week
Weekly Final
Salary
/ week
May We Contact
Your Supervisor?
 Yes No
Name of Supervisor
Title of Supervisor
Phone
Description
of Work
Reason for Leaving
Previous Employer
Employer
Name
Present Address
City
State
Zip
Starting Date
Leaving Date
Job Title
Weekly Starting
Salary
/ week
Weekly Final
Salary
/ week
May We Contact
Your Supervisor?
 Yes No
Name of Supervisor
Title of Supervisor
Phone
Description
of Work
Reason for Leaving


Meyer's Cleaning Online Employment Application - Part 4
Personal References *
Name
Address
Phone Number
Years

Acquainted
Service Record
Branch of Service
Discharge Date
Notes:


Other
Have you been convicted of a felony within the last 5 years?

 Yes No

If yes, please explain (will not necessarily exclude you from consideration)
Meyer's Cleaning Online Employment Application - Part 5
"I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they have have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employement for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative."
In leiu of your signature, we ask for your digital signature as your agreement to the above authorization. This digital signature is binding and you must answer truthfully as it was any other part of this application.
Your Digital Signature: What is your mother's maiden name: *
All Items Marked With The Asterisk ( * ) are required to continue.

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