EMPLOYMENT APPLICATIon

Applicants will receive consideration without regard to race, color, religion, national origin, ancestry, sex, age, disability, military status or any other legally protected status or characteristic. Kleenrite Company provides reasonable accommodation for qualified individuals with a disability, in accordance with the Americans with Disabilities Act and applicable state and local laws. Applicants requiring reasonable accommodation in order to participate in the interview process are requested to contact Kleenrite’s management in order to arrange such accommodation.

APPLICANT INFORMATION

First Name *

Last Name*

M.I.

Date

Message *

Street Address

Apartment/Unit #

City

State

ZIP

Phone

Email address *

Date Available to Start

Are you at least 18 years of age?

Yes

No

Position Seeking

Pay Desired

Referral

Job Fair

Walk In

Department of Labor

Online

Employee Referral:

Are you a citizen of the United States?

Yes

No

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

Yes

No

If so, when?

Have you ever been convicted of a felony?

Yes

No

If yes, explain

EDUCATION

High School

Address

From

To

Did you graduate?

Yes

No

College

Address

From

To

Did you graduate?

Yes

No

Degree

Other

Address

From

To

Did you graduate?

Yes

No

Degree

POSITION / AVAILABILITY

How many hours do you WANT to work each week?

Please fill in the hours each day you are available to work:

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

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

MILITARY SERVICE

Branch

From

To

Job Titles and Highlights of Training/Experience

REFERENCES

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Type the word *

Send