Employment
Employment Application - Please fill out all areas and click submit button at bottom of form. Thank You

NOTE: When entering information some boxes may turn yellow if you are using certain browser toolbars. Please fill in all of the boxes no matter what color you may see.



Full Name: Date:
Street Adress : City,State,Zip:
Phone: Home /Cell : Email:
Desired Wage: Are You 18 Years of age? Yes No
U.S. Citizen? Yes No Have you ever been
convicted of a felony?		 Yes No

Education
High School Adress
Did You Graduate? Yes No
College: Adress
Did You Graduate? Yes No

References
Full Name: Relationship: Phone #:
Full Name: Relationship: Phone #:
Full Name: Relationship: Phone #:

Previous Employment

List most recent employer first
Company: Phone:
Adress: Supervisor:
Date Started: Date Left:
Position / Title: List Duties and shift times:
Start / Ending Salary: Reason for Leaving:
       
Previous Employer      
Company: Phone:
Adress: Supervisor:
Date Started: Date Left:
Position / Title: List Duties and shift times:
Start / Ending Salary: Reason for Leaving:
       
Previous Employer      
Company: Phone:
Adress: Supervisor:
Date Started: Date Left:
Position / Title: List Duties and shift times:
Start / Ending Salary: Reason for Leaving:
       

Physical Requirements

This position requires certain physical abilities listed below. Please read and answer.
1. Lift and carry up to 50#
2. Stand and reach over your head to work while looking upwards at the same time.
3. Stand for extended periods of time.
Can you perform all of these tasks? Yes No
       

Disclaimer and Signature
I certify that the answers I have given are true and complete. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release and termination from employemnet with this company. I agree to all of this when I click the submit button below which will send this application to the employer.
       
       
MarKir Services Inc
651-308-0421 / Fax 715-381-1869 / email mark@cleanmidwest.com
       
       


Call us today at 651-308-0421.