Personal Information

1.  Name: Address:  City/State/Zip

     Number years at address: Daytime phone: Evening phone:

     Cell phone:  Email Address:

     Social Security Number:Date of Birth:

Who should be contacted if you are involved in an emergency?

2.  Contact Name: Relationship to you:

 

   Address:City/State/Zip:

 

   Daytime phone: Evening phone:

 

Positions: (Cleaner, Field Rep., Sales Rep, Tele-Marketing, Housecleaners, On-Call,   Special Service Cleaner)

 

                                            Job Position Your ApplyingFor:

 

 

3. Referral Source:Who referred you to our company?

 

4. Have you applied to our company previously? Yes No   If yes, when?

 

5. Are you at least 18 years old? Yes No    6. How will you get to work?

 

7. Driver's License Number: State issued your license?

 

8. Are you willing to work any shift, including nights & weekends? Yes No

        If no, please state any limitations & why?:

 

9. If you are offered employment, when would you be available to begin work?

 

10.  Are you legally eligible for employment in the United States? Yes No

 

11. Able to perform essential functions of the job position without constant supervision? Yes No

 

12. Have you ever been convicted of any crime, including traffic violations? Yes No

             If yes, please describe:

         Applicant Employment History:  Below list your current or most recent employment first.

                                                                                             JOB 1

  Last date you were last employed? (ex: m/d/yr to m/d/yr

 

     If not employed now, why?

 

Employer Name: Address: City/State/Zip:

 

Telephone:       Supervisor's Name

Job Title: Job Duties:

Beginning Hourly Rate or Salary Rate:   Last Hrly Rate or Salary Rate:

Reason for Leaving:   Did you leave on good terms?

 

Would you go back? (Yes or No)

 

                                                                                        JOB 2

Last date you were last employed? (ex: m/d/yr to m/d/yr

 

     If not employed now, why?

 

Employer Name: Address: City/State/Zip:

 

Telephone:       Supervisor's Name

Job Title: Job Duties:

Beginning Hourly Rate or Salary Rate:   Last Hrly Rate or Salary Rate:

Reason for Leaving:   Did you leave on good terms?

 

Would you go back? (Yes or No)

 

                                                                               JOB 3

Last date you were last employed? (ex: m/d/yr to m/d/yr

 

     If not employed now, why?

 

Employer Name: Address: City/State/Zip:

 

Telephone:       Supervisor's Name

Job Title: Job Duties:

Beginning Hourly Rate or Salary Rate:   Last Hrly Rate or Salary Rate:

Reason for Leaving:   Did you leave on good terms?

 

Would you go back? (Yes or No)

                          Applicant's Education and Training: List your education and training.

 

High School Name and Address Last Grade? 9 10 11 12   Diploma? Yes No

College Name & AddressDid you receive a degree? Yes No

If yes, degree received:Other Training (graduate, technical, vocational):

Awards, Honors, Special Achievements:

                                                        Applicant's Skills:

Check those skills that you have, list any other skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill.

    Note Below: 1 = poor ability,   5 = exceptional ability

               

  Skill                                            Years of Experience                            Ability or Rating

  Buffing Strip & Wax Carpet Cleaning Auto Burnisher Window Washing                  1 2 3 4 5                                              1 2 3 4 5

   To choose skill click on it.

 

  List any other skills here that may be useful for the job you are seeking.

 

             1 2 3 4 5   

 

 

   List personal attitude skills here: (ex: teamwork, dependable, self-motivator.)

 

            1 2 3 4 5

 

 

Additional Comments you may have:  

 

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                                References: List three UNRELATED people who would be willing to provide a reference.

 

Contact Name: Relationship to you:Address:

 

City/State/Zip: Daytime phone: Evening phone:

 

Contact Name: Relationship to you:Address:

 

City/State/Zip: Daytime phone: Evening phone:

 

Contact Name: Relationship to you:Address:

 

City/State/Zip: Daytime phone: Evening phone:

 

                                   Below,   you may provide any other information that you believe should be considered:

 

 

CERTIFICATION

I certify that the information provided on this Application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my Application, or if employment commences, immediate termination. I further understand it is my responsibility to advice KSB Services, Inc., if there should be any changes to my statements above, and failure to do so my result in disciplinary action up to and including dismissal. I understand that there is no contract or guarantee of hours of employment for a specified time, and accordingly, during the introductory period, or anytime thereafter, of KSB Services, Inc. my end the employment relationship, at will, anytime with our without cause. My signature below grants consent to verify all information and statements made on this application, including employment information. My signature below also grants consent to conduct an criminal investigation as a condition of my employment.

 

I authorize KSB Services, Inc. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

 

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its President, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of KSB Services, Inc., except in a specific written contract of employment signed on behalf of the organization by its President, has the power to alter or vary the voluntary nature of the employment relationship.I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

                        

         APPLICANT NAME                                                                        TODAY'S  DATE

 

APPLICANT EMAIL ADDRESS