Kwik N' Kleen Application for Employment


Personal Information

Last Name: First Name:
Address:
City: State: Zip:
Phone: Referred by:

 

Employment Desired

Position:
 Date available:

Salary desired:
Are you employed?
Yes           No 		If so, may we inquire of your present employer?
Yes           No
Ever applied with us before?
Yes           No 		Where?
 When?

 

Education History

Name & Location of School Years Attended Graduate? Subjects Studied

Grammar School:

  
High School:
 Yes
No
College:
 Yes
No

Trade, Business, or Correspondance School:

 Yes
No

 

General Information

Subjects of Special Study / Research Work or Special Training / Skills:
U.S. Military or Naval Service: Rank:

 

Former Employers

List below your last four employers, starting with the most recent:
Month & Year Employer Name & Address Salary Position Reason for Leaving
From:
To:

 
From:
To:

 
From:
To:

 
From:
To:

 

 

References

Give below the names and phone numbers of three persons not related to you, whom you have known at least one year.
Name Phone Business Years Known

 

Authorization

"I certify that the facts contained in this application are true and comjplete 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 employement 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.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment 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 compnay representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

By checking this box, you certify that you have read and agree to the above statement:
I agree*

*This is a required field to process your application. If you get the error message: "There was an error while processing your form input: Incorrect request to userForms", it was because you did not check this box!

Date: