Ramelli Janitorial Service / Please Leave Blank
Official Use Only

Employment Application Date: ______

Applicant Information

Full Name: /
:

Last

/

First

/

Middle

/ Maiden
Address:

Street Address

/

Apartment/Unit #

City

/

State

/

ZIP Code

Phone: /
Email
Date Available: /
Social Security No.:
/
If under 18, please list age:
Position Applied for: /
Desired Salary:
/ $______
Days/Hours Available to Work
(Please Circle)
No Pref.
Mon
Tue
Wed / Thurs
Fri
Sat
Sun
/ How many hours can you work weekly? ______
Can you work nights? ______
Employment desired: / Full-Time Only / Part-Time Only / Full Or Part - Time
When are you available for work? ______
Are you a citizen of the United States? / YES / NO /
If no, are you authorized to work in the U.S.?
/ YES / NO
Have you ever worked for this company? / YES / NO /
If yes, when?
Have you ever been convicted of a felony? / YES / NO /
If yes, explain?
Do you have a driver’s license? / YES / NO
What is your means of transportation to work?
Applicants may be tested for illegal drugs and alcohol any time prior and during employment.

License Information

Do you have a driver’s license? / YES / NO
If yes, please specify: / Operator
/ Commercial (CDL) / Chauffeur
State / License No. / Type / Expiration Date

Education

High School: /
Address:
From: /
To:
/
Did you graduate?
/ YES / NO /
Diploma:
College: /
Address:
From: /
To:
/
Did you graduate?
/ YES / NO /

Degree:

Other: /

Address:

From: /

To:

/

Did you graduate?

/ YES / NO /

Degree:

Military Service

Branch: /

From:

/

To:

Rank at Discharge: /

Type of Discharge:

Employment Record (Attach Sheet If More Space Is Needed)

Last Employer:
Company Name: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Any gaps in employment and/or unemployment must be explained. Please include dates (Month/Year) and reason.
Second Last Employer:
Company Name: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Any gaps in employment and/or unemployment must be explained. Please include dates (Month/Year) and reason.
Third Last Employer:
Company Name: /

Phone:

Address: /

Supervisor:

Job Title: /

Starting Salary:

/ $ /

Ending Salary:

/ $
Responsibilities:
From: /

To:

/

Reason for Leaving:

Any gaps in employment and/or unemployment must be explained. Please include dates (Month/Year) and reason.
May we contact your previous supervisors for a reference? / YES / NO

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature: /

Date:

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