Housekeeping Employment Application

Applicant Information

Last Name / First / M.I. / Date
Street Address / Apartment/Unit #
City / State / ZIP
Phone: / Cell Phone #:
Date Available / Social Security No. / Drivers License No. & State
How were you referred to Elliott Realty?
Are you at least 18 years old? / YES / NO
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 so, when?
Do you have any family member that
Currently work for Elliott Realty? / YES / NO / If yes, who?
Do you have yourown transportation? / YES / NO
Will you be working with a partner? / YES / NO / If yes, who?
Have you ever plead “guilty”, “no contest”
Or been convicted of a crime? / YES / NO / If yes, explain

Education

High School / Address
From / To / Did you graduate? / YES / NO / Degree
College / Address
From / To / Did you graduate? / YES / NO / Degree
Other / Address
From / To / Did you graduate? / YES / NO / Degree

Special Skills

Please list any special skills or qualifications:

Previous Employment

Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO
Company / Phone / ( )
Address / Supervisor
Job Title / Starting Salary / $ / Ending Salary / $
Responsibilities
From / To / Reason for Leaving
May we contact your previous supervisor for a reference? / YES / NO

Military Service

Branch / From / To
Rank at Discharge / Type of Discharge
If other than honorable, explain

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

Authorization to Release Information

Please be advised that I have applied for a position with Elliott Realty. I have been requested to provide information for their use in reviewing my background & qualifications. Therefore, I authorize the investigation of my character (criminal background check), education, military and employment qualifications.

The release in any manner of all information by you is hereby authorized whether such information is of record or not, and I do hereby release all persons, agencies and/or firms from any liability resulting from such information.

The authorization is valid for thirty (30) days from the date of my signature below. Please keep this copy of my release request for your files. Thank you for your cooperation.

First, Middle & Last Name: ______

Date of Birth: _____/_____/______Social Security #: ______

Street Address: ______

City, State and Zip Code: ______

Signature: ______Date: ______

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Please be advised, if I am offered and choose to accept employment with Elliott Realty, there will be a deduction of $38.00 from my first check. This deduction will cover the cost of my uniform and background check.

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