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Employment Application

If you are interested in becoming part of the Clean Supreme Team, please complete the following:

    Applicant Information

    First Name (required)
    Last Name (required)
    Email (required)
    Phone (required)
    Address (required)
    City (required)
    State (required)
    Zip (required)
    Date Available (required)
    Hours Per Week (required)
    Position Applied For (required)
    Do you have your own transportation? (required) YESNO
    Do you have a driver's license? (required) YESNO
    Are you a citizen of the United States? (required) YESNO
    Are you authorized to work in the U.S.? (required) YESNO
    Have you ever worked for this company? (requried) YESNO
    If yes, when? From:
    To:
    Have you ever been convicted of a felony? (required) YESNO

    Education

    High School
    Address
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    Did you graduate? YESNO
    Diploma:
    College
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    Did you graduate? YESNO
    Degree:

    References

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    Employer:
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    Previous Employment

    Company:
    Supervisor:
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    Starting Salary:
    Ending Salary:
    Job Title:
    May we contact: YESNO
    Responsibilities:
    Reason for leaving:
    Company:
    Supervisor:
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    May we contact: YESNO
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    May we contact: YESNO
    Responsibilities:
    Reason for leaving:

    Military Service

    Branch:
    Rank at Discharge:
    Start Date:
    End Date:
    Type of Discharge:
    If OTH, please explain:

    Resume

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    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 immediate release:

    Full Legal Name:
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