Application for Employment

General

Name
(first)  (middle)  (last)
Address   
City      Zip   
Home Phone       Cell Phone
Driver's License #   Email Address
Position Desired       Full-Time    Part-Time    Temp
Date Available to Work:
How long have you been a resident of this city or state?
Have you ever pleaded guility, no contest or been convicted of a crime?  Yes     No
If "Yes", please give dates and details:

Education

High School   Years Completed   Year Graduated
College  Years Completed  Year Graduated
Additional Comments

Previous Employment

1. Place of Employment   Type of Business 
Address
City         State     Dates Employed: From   To
Weekly or Hourly Rate of Pay   
Describe duties, Position:
Reason for leaving:
Name of Immediate Supervisor & Title:

2. Place of Employment   Type of Business 
Address
City         State     Dates Employed: From   To
Weekly or Hourly Rate of Pay   
Describe duties, Position:
Reason for leaving:
Name of Immediate Supervisor & Title:

References

1. Name    Address
Phone    Years Known

2. Name    Address
Phone    Years Known

Please state why you desire a position with Portage Cleaners & Laundry and why you feel you would make a valuable employee:


In submitting this application, I testify to the fac that the information provided in this application is true to the best of my knowledge.
I also realise that I may be required to complete and pass a drug test prior to hire or at any other time during employment.

I have completely read everything in this online application and agree to the conditions stated herein.  (You must check this box to submit this application.)