Employment Application
Programs, services, and employment are available to everyone. Please inform the Human Resources Department if you require reasonable accommodation for the application or interview.

Today's Date: (mm/dd/yyyy)

Applicant Data
How were you referred to us:

Position Applied for:


Full Name:

Address:

City:

State:

Zip:

Phone:

Cell/Other:

Email:

Date Available to Start: (mm/dd/yyyy)

Salary Requirements:

If you are under 18 years of age, can you provide a work permit?  Yes No

If no, please explain:

Have you ever worked for this company?  Yes No

If yes, when?

Are you a citizen of the United States?  Yes No
If not a citizen of the U.S., are you legally allowed to work in the United States?  Yes No N/A
Type of employment desired:  Full-Time Part-Time Temporary Seasonal
Do you have your own transportation?  Yes No

Explain(if necessary):

Have you ever pleaded guilty, no contest, or been convicted of a crime?  Yes No

If yes, give dates and details:

Answering yes to the question above does not constitute on automatic rejection for employment. Date of offense, seriousness and nature of the violation, rehabilitation, and position applied for will be considered.

Driver's License number (if applicable to position):

State:

is a friend, family member, or anyone you are associated with a current or past employee of Rick's Cleaners?  Yes No

If yes, please name individual(s):

Summarize Your Special Skills or Qualifications
Emergency Contact Information
Fullname:

Address:

City:

State:

Zip:

Phone:

Cell/Other:

Email:

Previous Employment (begin with most recent position)
  Current or Most Recent Prior Prior
Employer
Address
Phone
Name of Supervisor
Position/Job Title
Responsibilities
Dates of Employment:

Starting Date: (mm/dd/yyyy)

Starting Date: (mm/dd/yyyy)

Starting Date: (mm/dd/yyyy)

Ending Date: (mm/dd/yyyy)

Ending Date: (mm/dd/yyyy)

Ending Date: (mm/dd/yyyy)

Starting and Ending Pay

Starting Pay:

Starting Pay:

Starting Pay:

Ending Pay:

Ending Pay:

Ending Pay:

Reason for Leaving:
May we contact employer for a reference?  Yes No  Yes No  Yes No
Education
  Name/Location Last Year Complete Degree Received
High School
College/University
Trade School
Other
List any applicable special skills or training

 I certify that my answers are true and complete. I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational, financial, and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.


In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

Signature of Applicant:

Date: (mm/dd/yyyy)