-Application Form-

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Did you graduate?

Previous Employment

Please answer question to the best of your ability.


What hours are you available to work? Please check all that apply:

Voluntary Self Identifcation Form (Applicant)

The Equal Employment Opportunity Commission (EEOC) requires organizations with 100 or more employees to complete an EEO-1 report each year. Completion of this data is voluntary but we hope that you will choose to fill it out and it will not affect your opportunity for employment or terms or conditions of employment. This form will be used for EEO-1 reporting purposes only and will be kept separate from all other personnel records only accessed by Human Resources Dept. Please return completed forms with your applications of employment.


As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. Submission of this information is voluntary and refusal to provide it will not subject you to adverse treatment.

Voluntary Self-ID of Disability

As a Government contractor, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out.

Disabilities include, but are not limited to: Blindness, Deafness, Cancer, Diabetes, Epilepsy, Autism, Cerebral Palsy, HIV/AIDS, Schizophrenia, Muscular Dystrophy, Bipolar Disorder, Major Depression, MS, Missing or Partially Missing Limbs, PTSD, OCD, Impairments requiring the use of a wheelchair, Intellectual Disability.

Please mark one below:

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.

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job.

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.

Would you like to fill out the Voluntary Self Identifcation Form?

By pressing the submit button, you agree to the terms expressed above.

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