Classic Cleaners Employment Application

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Step -- 1 - 2 - 3

* Required Fields

Application Instructions

*Today's Date:
(e.g. 07/10/2002)

If you need help filling out this application or for any phase of the employment process, please notify the person that gave you this form and every effort will be made to accommodate your needs in a reasonable amount of time.

Please read "APPLICATION NOTE" below.

Complete both pages of this applications.

If more space is needed to complete any question, use comments section at the bottom of the page.

*First Name:

Middle Initial:

*Last Name:

Social Security
Number:

*Home Phone
Number:
(i.e. 3178469874)

Work Phone Number:
(i.e. 3178469874)

*Current Address 01: Prior Address 01:

Current Address 02: Prior Address 01:

*Current City: Prior City:

*Current State: Prior State:

*Current Zip code: Prior Zip code:

Application Notes

This form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness, or physical handicap, or the presence of disabilities. A conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Availability

*For which position are you applying?

*What date can you start? (e.g. 07/15/2002)

*What category would you prefer? Full-time Part-time Temporary Labor pool

*For which schedule are you available?
Weekdays Weekends Nights Overtime Shift Other

* reasonable efforts will be made to accommodate sincerely held religious beliefs and practices

Job-Related Skills

Note: Do not fill out any part of this section you believe to be non-job related.

Security		List states and counties of residence for the past seven years.

Yes No		Have you used any names or Social Security Numbers other then given above? Of so, please list them in the comments below.
Yes No		Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since the last conviction, nature of the job sought and rehabilitation effort will be reviewed.)

	Incident	City/State	Charge
1.
2.
3.

Comments

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Classic Cleaners, Inc. * 8641 Bash Street * Indianapolis, IN 46256 * 317-845-5244