Employment Application Name Email Address ---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming- Outside the United States - Birtdate: [date* birthdate 6/ date-format:mm/dd/yy first-day:0] Are you a citizen of the United States? Yes No Have you applied with or ever worked for CleanSuite Service? Yes No If yes, when? From [date work-start 6/ date-format:mm/dd/yy] to [date work-end 6/ date-format:mm/dd/yy] Position Wanted Job Title: Date Available: [date date-avail 6/ date-format:mm/dd/yy first-day:0] Salary Desired: $ Check any that apply: Full Time Part Time Day Shift Night Shift Education Begin with high school, then college or any military school you attended. Work Experience Please list the last 3 employers. Start with current or most recent. Dates of Employment: From [date emp-start-1 6/ date-format:mm/dd/yy] to [date emp-end1 6/ date-format:mm/dd/yy] Dates of Employment: From [date emp-start-2 6/ date-format:mm/dd/yy] to [date emp-end2 6/ date-format:mm/dd/yy] Dates of Employment: From [date emp-start-3 6/ date-format:mm/dd/yy] to [date emp-end3 6/ date-format:mm/dd/yy] Have you ever been convicted of a felony? Yes No Can you legally work in the United States? Yes No Are you a veteran of the U.S. Military Service? Yes No List 3 names of references whom we may contact to discuss the knowledge of your skills, talents, or other experience. I CERTIFY that the answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false of misleading information given on my application or interview may result in termination.