Job Application Name Email Address Address Number of Years at current address Phone How were you referred to us? If under 18, please list age If you are under 18, can you provide a valid work permit? If you are under 18, can you provide a valid work permit? Yes No Can you show proof of legal employment authorization & identity? Can you show proof of legal employment authorization & identity? Yes No Are you eligible to work in the United States? Are you eligible to work in the United States? Yes No Do you have any objection to overtime hours if necessary? Do you have any objection to overtime hours if necessary? Yes No Have you previously been employed by our organization? Have you previously been employed by our organization? Yes No If yes, please list dates of conviction, nature of offense, sentence and any rehabilitation. Have you ever been convicted of a crime? Have you ever been convicted of a crime? Yes No Work History Please list 3 previous employers in order, beginning with most recent. Work History Please list 3 previous employers in order, beginning with most recent. Name of Employer Address Can We Contact? Can We Contact? Yes No Position held Reason for leaving Job description/responsibilities Name of supervisor Dates of employment Phone number Name of Employer -------------------------- -------------------------- Address Can We Contact? Can We Contact? Yes No Reason for leaving Position held Job description/responsibilities Name of supervisor Dates of employment Phone -------------------------- -------------------------- Name of Employer Address Phone number Can We Contact? Can We Contact? Yes No Reason for leaving Position held Job description/responsibilities Name of supervisor Dates of employment -------------------------- -------------------------- References - Please list 3 personal or business references (no relatives). References - Please list 3 personal or business references (no relatives). Name Relationship Phone Number of years known Name Relationship Phone Number of years known Name Relationship Phone Number of years known Educational History - List school name and location, years completed, course of study, and any degrees earned. Educational History - List school name and location, years completed, course of study, and any degrees earned. High School College Technical training Other Position Information Position Information Type of employment desired Type of employment desired Full time Part time Check the days you are able to work Check the days you are able to work Monday Tuesday Wednesday Thursday Friday Saturday Sunday Do you have your own transportation/valid drivers license? Do you have your own transportation/valid drivers license? Yes No Available start date Are you available to work weekends/holidays/nights if necessary? Are you available to work weekends/holidays/nights if necessary? Yes No I attest that all information provided in this application is true and accurate. I understand that should I be offered employment with Dust to Shine, LLC. that I may be subject to a criminal background investigation and consent to this by submitting this application. I attest that all information provided in this application is true and accurate. I understand that should I be offered employment with Dust to Shine, LLC. that I may be subject to a criminal background investigation and consent to this by submitting this application. Yes 5 + 10 = Apply
