Please complete the entire application.
- Employer Information
Michigan Maid Cleaning Advantage
11770 Newburgh rd, Suite B, Livonia , Mi 48150
734-366-8676
It is the policy of Michigan Maid Cleaning Advantage to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.
- Applicant Information
Applicant Full Name: ___________________________________________
Home Address: ___________________________________________
City/State/ZIP: ___________________________________________
Number of years at this address: _________
Daytime phone:____________________Evening phone: ____________________
Mobile phone: ____________________
Social Security Number: ___________________________
Driver’s License (State/Number): ___________________________
- Emergency Contact
Who should be contacted if you are involved in an emergency?
Contact Name: ___________________________________________
Relationship to you: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Daytime phone:____________________Evening phone: ____________________
4.Job Position Applied For: Cleaning Team Member
5.Are you at least 18 years old?______ Yes ______ No 6.How will you get to work? _____________________________________ 7.Are you willing to work any shift, including nights and weekends? _____ Yes _____ NoIf no, please state any limitations:________________________________________________
- If applicable, are you available to work overtime? _____ Yes _____ No
- If you are offered employment, when would you be available to begin work?
____________________________________
- If hired, are you able to submit proof that you are legally eligible for
employment in the United States? _____ Yes _____ No
- Are you able to perform the essential functions of the job position you seek with
or without reasonable accommodation?______ Yes ______ No
What reasonable accommodation, if any, would you request?
________________________________________________
- Have you ever been convicted of a felony or misdemeanor?
______ Yes, I was convicted of ______________________________ on ____________ (date) in _________________ (city), _______________ (state)
______ No
THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.
- Applicant’s Skills
List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)
Ability or Skill________________________________________________________________________
Years of Experience__________________________________________________________________
- Applicant Employment History
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
Employer Name: ___________________________________________
Supervisor Name: ___________________________________________
Address: ___________________________________________
City/State/ZIP: ___________________________________________
Job Duties: ___________________________________________
Reason for Leaving: ___________________________________________
Dates of Employment (Month/Year): _____________________________
- Applicant’s Education and Training
College/University Name and Address_______________________________________________
______________________________________________________________________________________
Did you receive a degree?______ Yes _____ No If yes, degree(s) received: ___________
High School/GED Name and Address
____________________________________________________________
Did you receive a degree?______ Yes _____ No
Other Training (graduate, technical, vocational):
_______________________________________________________________________________________
Please indicate any current professional licenses or certifications that you hold:
________________________________________________________________________________________
Awards, Honors, Special Achievements:
_________________________________________________________________________________________
- References
List any two non-relatives who would be willing to provide a reference for you.
Name: ________________________________________________
Address: _________________________________________
City/State/ZIP: ___________________________________
Telephone: ________________________________________
Relationship: ________________________________________
Name: ________________________________________________
Address: _________________________________________
City/State/ZIP: ___________________________________
Telephone: _________________________________________
Relationship: _________________________________________
- Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:
_________________________________________________________________________________
_________________________________________________________________________________
CERTIFICATION
I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
I authorize Michigan Maid Cleaning Advabtage to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.
If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Michigan Maid Cleaning Advantage, except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.
I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.
____________________________________ _______________
APPLICANT SIGNATURE DATE