A F L Services

* INDICATES REQUIRED INFORMATION

* Full (Legal) Name:

* Birth Date: (mm/dd/yyyy)

*Complete Street Address, City, State, Zip

County (in which you live)

*Home Phone Number (xxx-xxx-xxxx)

*Mobile Phone Number (xxx-xxx-xxxx)

Email Address:

*Social Security Number: (xxx-xx-xxxx)

As "conditions" of employment, one must have your "own" dependable transportation and a valid drivers license.

Do you "OWN" dependable transporation?

Yes
No

*Please enter your "valid" drivers license number

*Please enter the expiration date of your drivers license: (mm/dd/yyyy)

*Position Applying For:

Cleaner
Supervisor
Other

Title of "other" position

*Date available: (mm/dd/yyyy)

CITIZENSHIP:

*Are you a citizen of the United States?

Yes
No
No however, I am legally authorized to work in the U.S.A.

CONVICTIONS:

*Have you ever been arrested "OR" convicted of a crime?

Yes
No

*If YES, please provide the date(s) and details of the arrest/conviction.

*Many of our clients require State and/or other criminal clearances. Are you willing to submit to such background investigations?

Yes
No
I currently possess a State Clearance due to the nature of my full time job that is not older than one year old.

EDUCATION:

*Highest Level of Education Completed

High School
College Degree - Associates or Bachelors
Graduate College Degree - Masters or Doctorate
None of the above.

*Name & address of the school you attended.

Name of current employer, job title and job responsibilities.

Date you began current full-time employment:

May we contact your current employer for reference?

Yes
No

PREVIOUS EMPLOYMENT:

Name & Address of Previous Employer, Job title & responsibilities.

Previous Employment Dates: (From - To)

May we contact your previous employer for reference?

Yes
No

Reason(s) you left your previous employment:

Cleaning positions require physical tasks such as, (but not limited to): bending, emptying trash, mop floors (both dust & wet mop), and vacuum.

*Do you have physical limitations that may include: being pregnant or injuries you've recently sustained that may become irritated with such activities?

Yes
No

*Please list all physical limitations.

MILITARY SERVICES:

*Did you serve in the Military?

Yes - Honorable Discharge
Yes - Dishonorable Discharge
No

Please list branch of military and dates of service:

REFERENCES: Please provide 2 Professional and 1 Personal Non-relative Reference

*Professional Reference #1 - Please provide Name, Address & Telephone Number.

*Professional Reference #2 - Please provide Name, Address & Telephone Number

*Personal/Non-Relative Reference - Please provide Name, Address & Telephone Number

DISCLAIMER:

*Disclaimer: I certify that my answers are true and complete to the best of my knowledge. If this applications leads to employment, I understand that false or misleading information on my application or in the interview may result in my termination. Selecting Yes below indicates my agreement with this disclaimer.

Yes
No

ELECTRONIC SIGNATURE & DATE:

*Signature: By typing my full legal name in the space provided below for submission, all information is correct and my electronic signature represents my understanding as such.

*Today's Date: (Month Day, Year)