How did you learn about CitiClean?
Please list any allergies*
School Name, Major/Course of Study, Dates Attended /Graduate?*
Are you currently employed?*
May we contact your present employer?*
Dates of Employment, Rate of Pay, Employer Name/Supervisor Name and Phone, Job Title, Reason for Leaving
Please list any special skills or training you have
What transportation will you use to get to and from work?*
Do you own or have access to a vehicle?*
Have you ever been convicted of violating Federal, State, County, or Municipal laws or ordinances (Other than minor traffic violations resulting in a fine of $25 or less)?*
Please do not list family members or former employers.
Name, How Known, Years Known, Phone#
Please give any additional information you feel is significant:
Important – PLEASE READ AND SIGN
As an Equal Opportunity Employer, CitiClean’s employment policies, as well as Federal and State Law, prohibit discrimination in employment based on race, color, religion, sex, national origin, physical handicap, or age with respect to individuals who are at least 18 years of age. CitiClean will keep an application for employment on file for 30 days.
As part of this application for employment, I hereby authorize CitiClean to investigate my references and to make an independent investigation of my character, conduct, and employment records. I further agree that failure to reveal any prior employer or giving false or misleading information in this application will be grounds for termination of employment. I understand that I have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature or scope of any such investigation.
I understand that any employment given me will be on a ninety day probationary basis, during which I may be terminated without a hearing on the cause. If employed by CitiClean, I will abide by its rules and regulations. I agree as a condition of employment to a complete physical examination and to submit to random drug and alcohol testing as a condition of employment. I also agree to sign an employment agreement.
Applicant Electronic Signature*