Employment Information

* Required Field

*Name:
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*Email: A value is required.

*Phone:
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*Address:
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*City:
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*State:
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*Zipcode:
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Employment Questions

*Postion applying for?
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*What type of work are you applying for?
Temporary work - such as summers or holidays
Regular part-time work
Regular full-time work

*What days and hours are you available to work?
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*If hired, on what date can you start working?
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*Can you work on the weekends?
Yes
No
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*Can you work evenings?
Yes
No
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*Are you available to work overtime?
Yes
No
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Salary desired:

Personal Information

*Have you ever applied at Harris Carpet Cleaning before?
Yes
No
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If yes, when?

*Do you have any friends, relatives, or acquaintances
working for Harris Carpet Cleaning?
Yes
No
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If yes, state name and relationship:

*If hired, would you have transportation to/from work?
Yes
No
Please make a selection.

*Are you over the age of 18?
(If under 18, hire is subject to verification of minimum legal age.)
Yes
No
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*If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States?
Yes
No
Please make a selection.

*If hired, are you willing to submit to and pass a controlled substance test?
Yes
No
Please make a selection.

*Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Yes
No
Please make a selection.

If yes, please describe the crime – state nature of the crime(s), when and where convicted and disposition of the case. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event, and the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered.):

Education, Training and Experience

High School Name:

City, State:

Number of years completed:

Did you graduate?
Yes
No

Year Graduated:

College / University Name:

City, State:

Number of years completed:

Did you graduate?
Yes
No

Degree / diploma earned:

Vocational School Name:

City, State:

Number of years completed:

Did you graduate?
Yes
No

Degree / diploma earned:

Military

Branch:

Rank in Military:

Total Years of Service:

Related details:

Former Employers

*1. Name of Employer:
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*Dates Employed:
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*Phone number:
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*Supervisor
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*Position:
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*Salary:
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2. Name of Employer

Dates Employed:

Phone number:

Supervisor

Position:

Salary:

Authorization

“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 employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.”

 Yes You must agree before submitting an application.

*Signature
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*Date
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*Date of Birth
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