GCS Employment Form

PERSONAL INFORMATION

Date (required)

Name (required)

Email (required)

Address (required)

Phone Number (required)

Cell Number (required)

Date of Birth (required)

Driver License Number (required)

EMPLOYMENT QUESTIONS

Are you 18 years of age or older? (required)
YesNo

How did you hear about us? (required)
Employment AdFriendWalk-InRelativeOtherWebsite

Are you currently able to be employed lawfully in this country? (required)
YesNo
G.C.S. will obtain documentation supporting proof of citizenship or immigration status.

Position Applied for: (required)
---1st Shift2nd Shift3rd Shift

Seeking: (required)
Full-TimePart-TimeAs Needed

Available date to start? (required)

Can you work overtime as needed? (required)
YesNo

If Yes, Current Employer Name:

If No, Please explain:

Are you currently laid off? (required)
YesNo

If Yes, Explain.

EDUCATION

Elementary Name:

Elementary Years Attended:

Elementary Graduated:

High School Name:

High School Years Attended:

High School Graduated:

College/Trade:

College/Trade Years Attended:

College/Trade Graduated:

MILITARY SERVICE

YesNo

Rank:

EMPLOYMENT HISTORY

Employer #1:

Address:

Phone No.:

Supervisor Name:

Reason for Leaving:

Dates of Employment

From:

To:

Start Pay:

Ending Pay:

Work Performed:

Employer #2:

Address:

Phone No.:

Supervisor Name:

Reason for Leaving:

Dates of Employment

From:

To:

Start Pay:

Ending Pay:

Work Performed:

Employer #3:

Address:

Phone No.:

Supervisor Name:

Reason for Leaving:

Dates of Employment

From:

To:

Start Pay:

Ending Pay:

Work Performed:

EMPLOYMENT QUALIFICATION QUESTIONNAIRE

How many days were you absent during the past year?
0-5 days6-10 days10+ days

Which previous employer did you like best and why?

We are a company with a zero tolerance for harassment and discrimination. Have you ever been accused of sexual or other harassment or employment discrimination?
YesNo

If Yes, Please Explain:

Have you ever been arrested for or convicted of a crime that has not been expunged by a court? A conviction does not bar you from employment. Type of conviction, when convicted are considered.
YesNo

If Yes, Please Explain:

PERSONAL REFERENCES

Reference #1 - Name:

Address:

Phone No.:

Yrs. Known:

Reference #2 - Name:

Address:

Phone No.:

Yrs. Known:

Reference #3 - Name:

Address:

Phone No.:

Yrs. Known:

ACKNOWLEDGEMENT
I hereby authorize the release of employment data pertaining to my employment with Glenn’s Cleaning Service LLC. I acknowledge and authorize a criminal background check and agree to submit to any lawful drug, alcohol, or other testing that may be required in obtaining and the continuation of employment. I fully understand that if employed, any misrepresentation or omission on this application can result in dismissal of employment at any time. This application or the hiring process is not considered an employment contract of any kind. I understand Glenn’s Cleaning Service may alter Employee Policies, Practices, and/or other Company Policies.

E-Signature (required):

Date (required):