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Peterson Cleaning, Inc.
843 North Madison Street
Rockford, IL. 61107
Phone # 815.961.1300
Fax # 815.961.1190 |
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| Application Information |
First Name:
Middle Name:
Last Name:
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Address:
Apt number
City:
State:
Zip:
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| Home Phone #:
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Cell Phone #:
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| Date Availible:
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Social Security #:
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Desired Salary:
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| Position Applied for:
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City Applied for:
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| Email Address:
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Birthdate:
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Are you a citizen of the United States?
Yes
No
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If no, are you authorized to work in the U.S.?
Yes
No
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Have you ever worked for this company?
Yes
No
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If so, when?
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Have you ever been convicted of a felony?
Yes
No
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| If Yes, Explain:
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| Education |
| High School:
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Address:
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| From:
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Did you graduate? Yes
No
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Did you graduate? Yes
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Degree:
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| Other:
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| From:
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Did you graduate? Yes
No
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Degree:
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| References |
| Please list three references |
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| Full Name:
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Relationship:
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Phone #:
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| Company:
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| Full Name:
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Relationship:
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Phone #:
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| Company:
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| Full Name:
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Relationship:
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| Company:
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| Previous Employment |
| Company:
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Supervisor:
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Phone #:
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Address:
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Starting Salary:
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Ending Salary:
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| Responsibilities:
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| From:
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To:
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Reason for Leaving:
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| May we contact your previous supervisor for a reference? Yes
No
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| Company:
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Supervisor:
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Phone #:
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Address:
City:
State:
Zip:
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Starting Salary:
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Ending Salary:
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| Responsibilities:
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| From:
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To:
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Reason for Leaving:
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| May we contact your previous supervisor for a reference? Yes
No
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| Company:
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Supervisor:
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Phone #:
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Address:
City:
State:
Zip:
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Starting Salary:
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Ending Salary:
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| Responsibilities:
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| From:
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To:
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Reason for Leaving:
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| May we contact your previous supervisor for a reference? Yes
No
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| Military Service |
| Branch:
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From:
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To:
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| Rank at Discharge:
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Type of Discharge:
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| If other than honorable, explain:
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| Questionaire |
| Please answer each question to the best of your ability. |
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Do you have any physical Condition that may limit your ability to perform the job for which you have applied?
Yes
No
If yes, please explain:
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Does heat, standing on your feet, or lifting cause you any difficulties?
Yes
No
If yes, please explain:
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My number one reason for seeking employment in a cleaning buisness is:
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I am applying to Peterson Cleaning, Inc. because:
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My friends describe me as:
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My previous (or current) employer describes me as:
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When considering dependability, thouroughness, or energy level I feel my strongest area is:
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When it comes to getting along with fellow employees I can always be counted on to:
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| Disclaimer and Agreement |
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 release. |
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By checking the box to the left, I herby authorize and request any present or former employer, school, police department, financial institution or other person having personal knowledge about me, to furnish bearer (Peterson Cleaning, Inc.) with any and all information in their possession regarding me in connection with an application for employment. A printout or photocopy of this authorization may be accepted with the same authority as the original, and I specifically waive any written notice from any present or former employer who may provide information based upon this authorized request. I understand this authorization is to be part of the submitted application that I filled out. |
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| By pressing the submit button, you agree to the terms expressed above. |
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