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This company is an equal opportunity employer and will not discriminate in the hiring process on the basis of sex, religion, race, color, age, national origin, ancestry, disability or any other protected class.
First Name *
Middle Name
Last Name *
Email Address *
Social Security Number *
Street Address *
City *
Zip Code *
State *
Work Phone
Home Phone
Are you legally eligible for employment in the U.S.A? *
Are you 18 years of age or older? *
Salary Desired *
Position *
Date you can start? *
Can you work overtime if necessary? *
Can you work: *

Languages spoken fluently: *

If other:
Languages read and written: *

If other:
Have you ever applied with this company before? *
If yes, when?
Were you referred by an employee? *
Applicant referred by:
Do you have reliable transportation? *
Have you ever been convicted of a felony? *
If yes, explain felony conviction type and dates:
EDUCATION AND TRAINING
High School:
Course of Study:
Name & Location:
No. Years Completed:
College:
Degree or Diploma:
Name & Location
Course of Study:
No. Years Completed:
Degree or Diploma:
Trade or Bussiness School
Name & Location:
Course of Study:
No. Years Completed:
Other:
Degree or Diploma:
Name & Location:
Course of Study:
No. Years Completed:
Degree or Diploma:
Special Training:
Name & Location:
Course of Study:
No. Years Completed:
Degree or Diploma:
Company 1
EMPLOYMENT HISTORY
EMPLOYMENT HISTORY: (List names of employers in consecutive order with present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references. Note: A job offer may be contingent upon acceptable references from current and former employers.)
Company Name
Employed (Month and Year)
Address and Telephone
Pay or Salary
Job Title and Work Performed
May we contact this employer for a reference?
Reason for Leaving
Company 2
Address and Telephone
Company Name
Employed (Month and Year)
Pay or Salary
Job Title and Work Performed
May we contact this employer for a reference?
Reason for Leaving
Company 3
Company Name
Employed (Month and Year)
Address and Telephone
Pay or Salary
Job Title and Work Performed
May we contact this employer for a reference?
Reason for Leaving
Upload Resume :
The information provided in this Application for Employment is true, correct and complete. If you employ me, any misstatement or omission of fact on this application may result in my dismissal.I understand that acceptance of an offer of employment creates no obligation upon you, the employer, to continue to employ me in the future.
Signature *
Date *
AFFIRMATIVE ACTION FORM
Completion of the below information is voluntary.
We consider all applicants for positions without regard to race, color, religion, sex, national origin, citizenship, age, mental or physical disabilities, veteran/reserve/national guard or any other similarly protected status. We also comply with all applicable laws governing employment practices and do not discriminate on the basis of any unlawful criteria. To be completed by applicant on a voluntary basis.
Please be advised that this survey is not a part f your official application for employment It will not be used for Interview purposes or for any hiring decision. This form will be filed separately from the application. The information will be used and kept confidential in accordance with applicable laws and regulations. In an effort to comply with requirements regarding government record-keeping, reporting and other legal obligations that may apply. We Invite you to complete this applicant data survey. Providing this information is STRICTLY VOLUNTARY. Failure to provide this information will not subject you to any adverse personnel decision or action. Your cooperation is appreciated.
First Name:
Last Name
M.I.
Social Security
Phone Number
Street
City
State
Zip Code
Sex
Please check one of the following Equal Employment Opportunity Identification Groups:



Please check one of the following referral sources:



If Other, what?
Applicant's Electronic Signature
CONSENT TO CRIMINAL BACKGROUND CHECK
I have been informed that Kleen-Tech Services Corporation (The Company) will conduct a criminal background check for employment purposes. I understand that a prior criminal conviction will not necessarily make me ineligible for employment. However, failure to consent to a criminal background check may lead to disciplinary action including and up to termination and/or may disqualify me from employment.
I hereby consent to a criminal background check prior to, at the beginning of, or at any time during my term employment, and authorize the release of the report and any other Information to the company. I hereby release the company, its divisions, affiliates and associates, and anyone acting on their behalf from any and all claims or liabilities of any nature arising from or related to the preparation of the information contained in the criminal background reports and the disclosure of such information for employment purposes.
First Name
Last Name
M.I.
Maiden Name:(if applicable)
Date of Birth
Social Security Number
Sex
Current Street Address
City
State
Zip Code
From
To
List other addresses where you have lived in the last 7 years:
Street Address
City
State
Zip Code
From
To
Applicant's Electronic Signature
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