Powerwash USA | Employment Application

Power Wash usa

124 S 7th Street ~ Denison IA 51442

PRE-EMPLOYMENT QUESTIONNAIRE-AN EQUAL OPPORTUNITY EMPLOYER

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PERSONAL INFORMATION

Required Fields *

DATE:

NAME (LAST, FIRST, MI) *

PRESENT ADDRESS *

STATE *

CITY *

ZipCode *

ARE YOU 18 YEARS OR OLDER?

CELL PHONE NO.

APPLICANT NOTE
This applicant 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 termination of the application process, or if discovered after employment, termination of employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientation, 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. 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.

DESIRED POSITION

DATE YOU CAN START

POSITION

SALARY DESIRED

IF SO MAY WE INQUIRE WITH YOUR PRESENT EMPLOYER?

ARE YOU EMPLOYED NOW?

Yes

REASON FOR LEAVING?

EVER APPLIED WITH THIS COMPANY BEFORE?

Where?

WHEN?

Yes

EVER WORKED FOR THIS COMPANY BEFORE?

Where?

Yes

WHEN?

SHIFT AVAILABLE FOR WORK

DAYS AVAILABLE FOR WORK

WOULD YOU BE WILLING TO BE ON CALL IN CASE OF AFTER HOUR EMERGENCIES?

Yes

Education

NAME & LOCATION
OF SCHOOL

NO. OF YEARS
ATTENDED

DID YOU
GRADUATE?

SCHOOL LEVEL

SUBJECTS STUDIED

HIGH SCHOOL

COLLEGE

TRADE, BUSINESS OR
CORRESPONDENCE SCHOOL

LIST BELOW THE MOST RECENT EMPLOYER

NAME OF PRESENT OR LAST EMPLOYER

ADDRESS

STATE

CITY

Zip Code

STARTING DATE

HAVE YOU EVER VEEN CONVICTED OF A FELONY WITHIN THE PAST 5 YEARS?

Yes

IF YES EXPLAIN, (WILL NOT NECESSARILY EXCLUDE YOU FROM CONSIDERATION).

NOTE do not fill out any part of this section you believe to be non-job related.

JOB RELATED SKILLS

Do you have a valid driver's license? *

Yes

If no when will you have one?

Do you have reliable transportation to get to work? *

Yes

Do you have a smart phone? *

If yes, please enter number:

Yes

Do you have an email?

Yes

If yes, please enter email.

Please list any skills you feel would be of value to the job

Yes

Do you speak Spanish?

CERTIFICATION AND RELEASE

I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentation of the facts called for in this application, whether on the document or not, may result in rejection of my applicaiton 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 concerning my background and hereby release any said persons, schools, companies, and law enforcement authorities from any liability for any damage whatever 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 drug testing to detect the use of illegal drugs prior to and during employment.

Electronic Signature Agreement.

By selecting the "Submit Application" button, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application.

Consent to Electronic Delivery

You specifically agree that all information contained in this application may be sent electronically and that PowerWash USA Inc. cannot guarantee the delivery of the information contained in this application.

Date of Signature

SIGNATURE

Email Address