Apply Applicant Name (*) Phone (*) Email Address (*) Address (*) Number of Years at current address (*) If under 18, please list age How were you referred to us? (*) Do you have any objection to overtime hours if necessary? (*) yesno If you are under 18, can you provide a valid work permit? yesno Can you show proof of legal employment authorization & identity? (*) yesno Have you previously been employed by our organization? (*) yesno Are you eligible to work in the United States? (*) yesno Have you ever been convicted of a crime? (*) yesno If yes, please list dates of conviction, nature of offense, sentence and any rehabilitation. Work History Please list 3 previous employers in order, beginning with most recent. Name of Employer Address Can we contact? (*) yesno Reason for leaving (*) Job description/responsibilities (*) Position held Name of supervisor Phone number (*) Dates of employment Start: End: Salary Name of Employer Address Can we contact? (*) yesno Reason for leaving (*) Job description/responsibilities (*) Position held Name of supervisor Phone number (*) Dates of employment Start: End: Salary Name of Employer Address Can we contact? (*) yesno Reason for leaving (*) Job description/responsibilities (*) Position held Name of supervisor Phone number (*) Dates of employment Start: End: Salary 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. High School (*) College Technical training Other Position Information Type of employment desired (*) Full timePart time Check the days you are able to work (*) MondayTuesdayWednesdayThursdayFridaySaturdaySunday Do you have your own transportation/valid drivers license? (*) yesno Are you available to work weekends/holidays/nights if necessary? (*) yesno Available start date (*) All fields marked with (*) are required 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.
