Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How long at present address?
Email Address
*
Phone
*
(###)
###
####
Age
*
Are you atleast 18 years old?
Work eligibility
*
If hired can you provide proof that you are eligible to work in the US (i.e. birth certificate, proof of US citizenship, other documentation...)?
Social Security Number
Crime Conviction
Have you been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? (A conviction record will not necessarily be a bar to employment)
Start date
If hired today, when is the first possible date you could start?
MM
DD
YYYY
Sunday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Monday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Tuesday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Wednesday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Thursday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Friday
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
Saturday
*
Select availability
Morning only (7a-3p)
Evening only (3p-11p)
Either shift (7a-3p and/or 3p-11p)
Not available
How many hours per week can you work?
High school
Name and location of your HS? Did you graduate?
Trade/Business School
Name & location of school. Did you graduate? What was your course of study?
College
Name and location of school. Did you graduate? What was your course of study?
Skills & Qualifications
List any special qualifications, skills, training, or talents you have that you think will be relevant for this job?d
Name and address
List employer name and address
Job title
List job title and duties.
Start and End
When did you start? When did you leave? Why did you leave? Hourly rate/salary?
Name and address
List employer name and address
Job title
List job title and duties.
Start and End
When did you start? When did you leave? Why did you leave? Hourly rate/salary?
Certification and Acknowledgement
*
I certify that the information on my application is true and complete to the best of my knowledge. I understand that any incorrect, incomplete, exaggerated or false information furnished by me will subject me to disqualification or to the discharge from employment at any time. Further, I understand and acknowledge that any employment relationship with Collins Wash N Dry is of an “at will” nature, which means that the
employee may resign at any time and the employer may discharge the employee at any time without cause or notice. I further understand that this “at will” employment relationship may not be changed by any expressed or implied contract.
