Careers With Cleanstar

Employment Application

EQUAL OPPORTUNITY EMPLOYER

1 Personal Information

2 Employment Desired

3 Education

4 Employment History

5 Disclosures

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, veteran status, disability, or any other legally protected status. This employment application will remain active for a period of ninety days (90) from date of application. To be considered for employment, a new application will be required.
Position Applied For*
Date of Application*
Name

First
Last
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country

EMPLOYMENT DESIRED
Phone
Social Security Number
Can you provide required proof of your eligibility to work?*
Have you ever filed an application with us before?
If yes, give date:
Are you currently employed?*
May we contact your present employer?*
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?*
On what date would you be available for work?*
Are you available to work?
Do you have reliable transportation? *
Are you available to work weekends?*
Would you be available to work overtime if necessary?*
Do you have any friends or relatives working for our company?*
If yes, state name(s) and relationship(s)*
Why are you applying for work at our company?*
Are you able to perform the essential functions of the job for which you are applying?*
If no, describe the functions that cannot be performed*
If no, describe functions that cannot be performed.

EDUCATION, TRAINING & EXPERIENCE
High School
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Year Graduated
College/University
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Year Graduated
Did you complete
Vocational Business
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Did you complete
Health Care
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Did you complete
Answer if applying for a driving position
Are you licensed for the job applied for?
Name of license
License number/State
Has your license ever been revoked or suspended?
If yes, state reason(s), date of revocation, or suspension and date of reinstatement.

Employment History
Name of Employer
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Type of Busiess
Phone
Supervisor Name
Your Position & Duties
Dates of Employment
Weekly Pay
Reason for Leaving
Name of Employer
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Type of Busiess
Telephone #
Supervisor Name
Your Position & Duties:
Dates of Employment
Weekly Pay
Reason for Leaving
Disclosures
CLEANSTAR NATIONAL, INC.
Disclosure Statement & Authorization

This disclosure statement and authorization is provided to comply with the Fair Credit Reporting Act 15, U.S.C. 1681. The Fair Credit Reporting Act governs an employer’s use of certain consumer reports on applicants, employees or independent contractors.

Cleanstar National, Inc. may obtain a consumer report on you for employment purposes as a part of the pre-employment background investigation and at any time during your employment. This consumer report may disclose information about your driving record, criminal history (if any), credit history, character, general reputation or mode of living.

For security reasons, clients and clients’ principals may be given access to employee personnel files, including investigative reports on employees.

By signing below, you authorize Cleanstar National, Inc. to obtain a consumer report on you as part of its pre-employment or post-employment background investigation of you. If you are hired, this authorization shall remain on file and serve as ongoing authorization for Cleanstar National, Inc. to obtain consumer reports on you at any time during your employment period.
True and Complete Legal Name

First
Last
Middle
Maiden or Other Names Used
Dates Used
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Dates At Current
If less then 7 years please fill out below
Years at residence
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Years at residence
Address

Street Address
Address Line 2
City
State / Province / Region
Zip / Postal Code

Country
Birth date
Social Security #
Please type your name
Date

Name

First
Last
Witness
Date

Careers With Cleanstar

Employment Application

EMPLOYMENT DESIRED

EDUCATION, TRAINING & EXPERIENCE

Answer if applying for a driving position

Employment History

Disclosures

If less then 7 years please fill out below