Application for Employment - Premier Pro Wash & Seal

EMPLOYMENT APPLICATION

Employer Information
Employer:
Premier Pro Wash & Seal, LLC

Address:
Nottinghill Sky Dr.

City/State/ZIP:
Apollo Beach, Florida 33572

Telephone:
813-335-2869

It is the policy of Premier Pro Wash & Seal, LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
1. Applicant Information
Applicant Full Name*
First Middle Last
Home Address*
Street Address City State ZIP Code
Number of years at this address
Daytime Phone
Evening Phone
Mobile Phone*
Social Security Number*
Driver's License State*
State
Driver's License Number*
2. Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name*
First Middle Last
Relationship to you*
Address*
Street Address City State ZIP Code
Daytime Phone*
Evening Phone
3. Job Position
Job Position Applied For*
4. Salary
Salary Desired*
5. Referred By
Who referred you to our company?*
6. Previous Application
Have you applied to our company previously?
- Yes
- No
If yes, when?
MM slash DD slash YYYY
7. Age
Are you at least 18 years old?*
- Yes
- No
8. Transport
How will you get to work?*
Any driving infractions or accidents within the past three years?
- Yes
- No
If Yes, please explain
9. Overtime
If applicable, are you available to work overtime?
- Yes
- No
10. Start Date
If you are offered employment, when would you be available to begin work?*
MM slash DD slash YYYY
11. Employment Eligibility
If hired, are you able to submit proof that you are legally eligible for employment in the United States?
- Yes
- No
12. Accommodation
Are you able to perform the essential functions of the job position you seek with or without reasonable accommodation?
- Yes
- No
What reasonable accommodation, if any, would you request?
13. Criminal Record
Have you ever been convicted of a felony or misdemeanor?*
- Yes
- No
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
Yes, I was convicted of
On Date
MM slash DD slash YYYY
in City/State
City State
14. Applicant's Skills
You can add up to 5 skills
List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
Skill*
Years of Experience*
Please enter a number from 0 to 100.
Rating*
- 1
- 2
- 3
- 4
- 5
Write "ADD" in the box below to add another skill
Skill
Years of Experience
Please enter a number from 0 to 100.
Rating
- 1
- 2
- 3
- 4
- 5
Write "ADD" in the box below to add another skill
Skill
Years of Experience
Please enter a number from 0 to 100.
Rating
- 1
- 2
- 3
- 4
- 5
Write "ADD" in the box below to add another skill
Skill
Years of Experience
Please enter a number from 0 to 100.
Rating
- 1
- 2
- 3
- 4
- 5
Write "ADD" in the box below to add another skill
Skill
Years of Experience
Please enter a number from 0 to 100.
Rating
- 1
- 2
- 3
- 4
- 5
15. Applicant Employment History
You can add up to 5 employments
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue by using the Other Information box at the bottom of this form.
Company Name*
Supervisor Name*
First Last
Address*
Street Address City State ZIP Code
Job Duties*

List number of duties (comma separated) that you performed on the job
Reason for Leaving*
Dates of Employment*
MM slash DD slash YYYY

From Date
Dates of Employment*
MM slash DD slash YYYY

Till Date
Write "ADD" in the box below to add another Employment history
Company Name
Supervisor Name
First Last
Address
Street Address City State ZIP Code
Job Duties

List number of duties (comma separated) that you performed on the job
Reason for Leaving
Dates of Employment
MM slash DD slash YYYY

From Date
Dates of Employment
MM slash DD slash YYYY

Till Date
Write "ADD" in the box below to add another Employment history
Company Name
Supervisor Name
First Last
Address
Street Address City State ZIP Code
Job Duties

List number of duties (comma separated) that you performed on the job
Reason for Leaving
Dates of Employment
MM slash DD slash YYYY

From Date
Dates of Employment
MM slash DD slash YYYY

Till Date
Write "ADD" in the box below to add another Employment history
Company Name
Supervisor Name
First Last
Address
Street Address City State ZIP Code
Job Duties

List number of duties (comma separated) that you performed on the job
Reason for Leaving
Dates of Employment
MM slash DD slash YYYY

From Date
Dates of Employment
MM slash DD slash YYYY

Till Date
Write "ADD" in the box below to add another Employment history
Company Name
Supervisor Name
First Last
Address
Street Address City State ZIP Code
Job Duties

List number of duties (comma separated) that you performed on the job
Reason for Leaving
Dates of Employment
MM slash DD slash YYYY

From Date
Dates of Employment
MM slash DD slash YYYY

Till Date
16. Applicant's Education and Training
Highest Level of Education*
Did you receive a degree?*
- Yes
- No
If yes, degree(s) received
Other Training (Technical/Vocational)
Please indicate any current professional licenses or certifications that you hold
Awards, Honors, Special Achievements
Military Service
- Yes
- No
Branch
Specialized Training
17. References
List any two non-relatives who would be willing to provide a reference for you
Name*
First Last
Address*
Street Address City State ZIP Code
Telephone*
Relationship*
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Telephone*
Relationship*
18. Other Information
Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Premier Pro Wash & Seal, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Premier Pro Wash & Seal, LLC, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.*
I HAVE CAREFULLY READ THE BELOW CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.*(required)
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Premier Pro Wash & Seal, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Premier Pro Wash & Seal, LLC, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.
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EMPLOYMENT APPLICATION

Employer Information

1. Applicant Information

2. Emergency Contact

3. Job Position

4. Salary

5. Referred By

6. Previous Application

7. Age

8. Transport

9. Overtime

10. Start Date

11. Employment Eligibility

12. Accommodation

13. Criminal Record

14. Applicant's Skills

15. Applicant Employment History

16. Applicant's Education and Training

17. References

18. Other Information

CERTIFICATION