Monarch Cleaners

First Name: MI: Last Name:

SS# - -

Email Address:

Home Phone: ( ) - - Work Phone: ( ) - -

Present Address:

City: State: Zip Code:

How long have you lived at this address?

Job applied for:

How did you learn of this opening?

Applicant Note

This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in you body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Availability

List hours available to work per week:

Monday		Tuesday		Wednesday
From	To	From	To	From	To

Thursday		Friday		Saturday		Sunday
From	To	From	To	From	To	From	To

Are you interested in: Full-Time Part-Time

How many hours per week would you like to work?

Background

HOW WOULD YOU RATE YOURSELF
(1=Improvement needed 2=OK 3=Good 4=Top Performer)

Energy Level: Your sense of urgency, self-motivation and enthusiasm.
Communication Skills: Your ability to listen well, express ideas clearly and accept feedback.
Hospitality: Your natural friendliness and customer service skills.
Reliability: Your dependability, attendance, self-discipline and dedication.
Personal Pride: Your appearance, hygiene and achievement.
Teamwork: Your cooperation with others and team spirit.

1. What achievement in life are you most proud of?
2. What are your personal strength?
3. What are your weakest areas?
4. What are your five year goals?
5. Why do you want to work here?

Do you have reliable transportation to work? Yes No

Do you have any relative or friends currently working for Monarch Cleaners? Yes No

If yes, state relationship to you and location of employment

In the event you are required to use your personal or company automobile to conduct company business, please complete the following:

Do you have a valid driver's license? Yes No If yes, indicate State and Number
Do you have automobile liability insurance? Yes No
Do you have an moving violations? Yes No

Are you 18 years of age or older? Yes No If no, Date of Birth mm dd yyyy
Have you ever been convicted of any felony? Yes No
Have you ever been convicted of any crime, excluding misdemeanors? Yes No
Have you ever been convicted of any crime involving violence to another person? Yes No
Have you ever been convicted of any crime involving dishonesty? Yes No
Are you serving probation for any misdemeanor offense? Yes No
Have you ever been counseled or disciplined for cash handling violation? Yes No

Previous Employment

List below, beginning with your most recent, all present and past employment.

MOST RECENT EMPLOYER
Employer Name:
Address: City: State: Zip Code:
Phone Number: ( ) - -
Are you currently working for this employer? Yes No
If yes, may we contact? Yes No

From		To		Last Position Held		Weekly Starting Salary	Weekly Last Salary
Mo.	Yr.	Mo.	Yr.	Title	Duties	Weekly Starting Salary	Weekly Last Salary

Reason for leaving: Supervisor:

SECOND MOST RECENT EMPLOYER
Employer Name:
Address: City: State: Zip Code:
Phone Number: ( ) - -

From		To		Last Position Held		Weekly Starting Salary	Weekly Last Salary
Mo.	Yr.	Mo.	Yr.	Title	Duties	Weekly Starting Salary	Weekly Last Salary

Reason for leaving: Supervisor:

THIRD MOST RECENT EMPLOYER
Employer Name:
Address: City: State: Zip Code:
Phone Number: ( ) - -

From		To		Last Position Held		Weekly Starting Salary	Weekly Last Salary
Mo.	Yr.	Mo.	Yr.	Title	Duties	Weekly Starting Salary	Weekly Last Salary

Reason for leaving: Supervisor:

References

Name:
Address: City: State: Zip Code:
Occupation: Phone Number: ( ) - -

Education

HIGH SCHOOL
Name:
Address: City: State: Zip Code:

Course of Study	Years Attended		Last Year Completed	Did you Graduate?	List Diploma or Degree	Grade Average
	From	To
				Y N

COLLEGE/VO-TECH
Name:
Address: City: State: Zip Code:

Course of Study	Years Attended		Last Year Completed	Did you Graduate?	List Diploma or Degree	Grade Average
	From	To
				Y N

OTHER
Name:
Address: City: State: Zip Code:

Course of Study	Years Attended		Last Year Completed	Did you Graduate?	List Diploma or Degree	Grade Average
	From	To
				Y N

Comments

Comments:

Certification and Release

By checking this box, I certify that I have read and understand the applicant note and that the answers given by me to the foregoing information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejections of my application or discharge at any time during my employment. I authorize the company and/or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to a drug testing to detect the use of illegal drugs prior to and during employment.