Full Name:  * Date of Birth:  * Gender? Please select from listFemaleMale Email Address:  * Current Address: No. of years at this address? Prior address: No. of years at this address? Contact Number:  * Best Time To Call: Please select from listAMPM Experience/Qualifications? Clerical Commercial Office Cleaning Customer Service Floor Care (Carpet Shampoo) Floor Care (Strip Wax Buff) Food Service Hotel/Motel Clerk Insurance Rep Janitorial Certificate Manufacturing Private Care Aid Residential House Cleaning Restaurant Sales Window Washing Check all that apply (a check in any box will not disqualify applicant for position): Asthma Difficulty Bending/Kneeling High Blood Pressure Difficulty Standing Long Hours I Can't lift up to 50 lbs I do not have my own transportation with insurance I do not have a valid drivers license I have been convicted of a criminal offense What method of transportation will you use for work? Please select from listpublic transportationmy own cara friend will drive me What language(s) do you speak fluently? Position of interest: Please select from listReceptionistAdministrative AssistantCommercial CleanerDriverResidential House CleanerTeam Supervisor Employment History: (Supply the names address and number of your employers for the last 5 years. Remember to include dates employed salary job description and reason for leaving): Why should Atomic Klean hire you?  * In submitting this application I certify that all of the information is true and correct as of the date of submission. I understand that any misrepresentation omission or falsification of the information provided will be considered grounds for rejection of employment or termination of employment. I understand that 1.) Atomic Klean has a criminal background drug and alcohol policy that provides for pre-employment testing as well as testing after employment, 2.) consent to and compliance with such policy is a condition of my employment, and 3.) continued employment is based on the successful passing of testing under such policy. I understand that if this application results in a subsequent personal interview for employment that I will be asked to furnish certain references concerning my work history. I understand that prior to employment Atomic Klean will conduct any investigation necessary concerning any part of my background related to the position I am seeking including but not limited to the obtaining of a consumer report driving record and criminal background report. I understand that if employed by Atomic Klean I will be responsible for familiarizing myself with all rules and regulations of the company as they currently exist and are further modified. I will abide by Atomic Klean rules and regulations which I understand are subject to change at any time. I also understand that no employee of Atomic Klean may enter into a separate work agreement with any Atomic Klean clients unless employment has been terminated for no less than 2 years. I understand that if hired my employment is for no definite period of time and may be terminated by either party at any time. I agree to a criminal background check drug screen and driving history check prior to employment. Yes No Security code:   * Do not enter anything in this field:

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