Bethany Beach Cleaning, LLC

Part-Time Employment Application

Applicant Information

Applicant Name: _____________________
Home Phone: ________________,  Cell Phone:_______________,  Email Address Email

Current Address: _______________________________________________________
 

How were you referred to Company? _____________________________

Positions

Position(s) applying for: _________________________________________

Are you applying for:

         Temporary part-time work such as summer or holiday work? [ ] Y or [ ] N

         Regular part-time work? [ ] Y or [ ] N
 

What days and hours are you available for work? ______________________

If applying for temporary work, when will you be available? _______________________

If hired, on what date can you start working? __________________________________

Can you work on the weekends? [ ] Y or [ ] N

Can you work evenings? [ ] Y or [ ] N

Personal Information:

Have you ever applied to / worked for Company before? [ ] Y or [ ] N
If yes, please explain (include date): ______________________________________

If hired, would you have transportation to/from work? [ ] Y or [ ] N

Are you over the age of 18? If under 18, do you have working papers? [ ] Y or [ ] N

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? [ ] Y or [ ] N

If hired, are you willing to submit to and pass a controlled substance test? [ ] Y or [ ] N

Have you ever been convicted of a criminal offense (felony or misdemeanor)? [ ] Y or [ ] N

If yes, please state the 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.

Education, Training and Experience

High School:
School name:
______________________ School Address: ______________________________

Number of years completed: Years
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: Diploma

College / University/Vocational School:
School name:
Name
School address: Address
Number of years completed: Years
Did you graduate? [ ] Y or [ ] N
Degree / diploma earned: Degree

Additional Information

Do you have any other experience, training, qualifications, or skills which you feel should be brought to our attention, in the case that they make you especially suited for working with us?
[ ] Y or [ ] N

If yes, please explain ___________________________________________

Employment History

Are you currently employed? [ ] Y or [ ] N

If you are currently employed, may we contact your current employer? [ ] Y or [ ] N

Below, please describe past and present employment positions, dating back five years. Please account for all periods of unemployment. Even if you have attached a resume, this section must be completed.

Name of Employer:_________________________________________
Name of Supervisor: _________________________________________
Telephone Number: _________________________________________
Business Type: _________________________________________
Address:  _________________________________________

Length of Employment (Include Dates): ______________________
Position & Duties_________________________________________
Reason for Leaving: _________________________________________
May we contact this employer for references? [ ] Y or [ ] N

Name of Employer:__________________________________________
Name of Supervisor: __________________________________________
Telephone Number: _________________________________________
Business Type: _________________________________________
Address: _________________________________________

Length of Employment (Include Dates): _________________________________________
Position & Duties_________________________________________
Reason for Leaving: _________________________________________
May we contact this employer for references? [ ] Y or [ ] N

Name of Employer:__________________________________________
Name of Supervisor: _________________________________________
Telephone Number: _________________________________________
Business Type: Type
Address: _________________________________________

Length of Employment (Include Dates): _________________________________________
Position & Duties_________________________________________
Reason for Leaving: _________________________________________
May we contact this employer for references? [ ] Y or [ ] N

References

List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.

Name - First, Last: _________________________________________
Telephone Number: _________________________________________
Address: _________________________________________
Occupation: _________________________________________
Number of Years Acquainted: _________________________________________

Name - First, Last: _________________________________________
Telephone Number: _________________________________________
Address: _________________________________________
Occupation: _________________________________________
Number of Years Acquainted: _________________________________________

Name - First, Last: _________________________________________
Telephone Number: _________________________________________
Address:
Address City, state, zip: _________________________________________
Occupation: _________________________________________
Number of Years Acquainted: _________________________________________

Please Read and Initial Each Paragraph, then Sign Below

I certify that I have not purposely withheld any information that might adversely affect my chances for hiring. I attest to the fact that the answers given by me are true & correct to the best of my knowledge and ability. I understand that any omission (including any misstatement) of material fact on this application or on any document used to secure can be grounds for rejection of application or, if I am employed by this company, terms for my immediate expulsion from the company.
_____

I understand that if I am employed, my employment is not definite and can be terminated at any time either with or without prior notice, and by either me or the company.
_____

I permit the company to examine my references, record of employment, education record, and any other information I have provided. I authorize the references I have listed to disclose any information related to my work record and my professional experiences with them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers & all other persons, corporations, partnerships & associations from any & all claims, demands or liabilities arising out of or in any way related to such examination or revelation.
_____

Applicant's Signature:______________________________ Date:______________________________

 

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