APPLICATION FOR EMPLOYMENT

APPLICANTS MAY BE TESTED FOR ILLEGAL DRUGS

PLEASE PRINT ALL ANSWERS EXCEPT FOR SIGNATURE PERSONAL INFORMATION Name _________________________________________________________________________ Last First Middle Maiden/Suffix (Jr) Present Address__________________________________________________________________ How Long _________________ Social Security Number (PROVIDE ONLY IF HIRED)_____ Email ____________________________ DATE: ______________

Telephone Number(______) ______ - ____________ Drivers License Yes No State ____

Number _________ Expiration ___________

How will you get to work? __________________________________________________________ List any Military Experience: ________________________________________________________ EMPLOYMENT DESIRED Position_____________________________ Date You Can Start__________________________ Yes No No

Desired Salary _____________________ Are You Employed Now? Are you legally authorized to work in the United States? Yes

List days/hours that you are NOT available to work ______________________________________ Have you ever been convicted of a crime? Yes No

If yes, explain each conviction(s), nature of offense(s) committed, sentence(s) imposed, and type(s) of rehabilitation. (This will not necessarily affect your application).

EDUCATION HISTORY Did you graduate high school or receive a high school equivalency dipoloma? If no, circle highest grade completed 1 2 3 4 5 6 7 8 9 10
TYPE OF SCHOOL High School College/Universit y Bus./Trade/Prof. NAME OF SCHOOL COMPLETE ADDRESS DATES ATTENDED FROM TO

Yes 11 12

No

MAJOR & DEGREE

DID YOU GRADUATE?

EMPLOYMENT HISTORY Please list your work experience for the past five years beginning with your most recent or current job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer: Address: Phone number: Employment Dates: From To Number of hours worked per week: Reason for leaving (be specific): Name of last supervisor: Title of supervisor: Your last job title & duties: Salary or Wage: Start Final

Name of employer: Address: Phone number: Employment Dates: From To Number of hours worked per week: Reason for leaving (be specific):

Name of last supervisor: Title of supervisor: Your last job title & duties: Salary or Wage: Start Final

Name of employer: Address: Phone number: Employment Dates: From To Number of hours worked per week: Reason for leaving (be specific):

Name of last supervisor: Title of supervisor: Your last job title & duties: Salary or Wage: Start Final

Name of employer: Address: Phone number: Employment Dates: From To Number of hours worked per week: Reason for leaving (be specific):

Name of last supervisor: Title of supervisor: Your last job title & duties: Salary or Wage: Start Final

May we contact your present employer?

Yes

No

REFERENCES Please list two references other than relatives or previous employers. Name_________________________________ Position _______________________________ Name__________________________________ Position_________________________________

Company ______________________________ Company________________________________ Address _______________________________ Address_________________________________ Telephone _____________________________ Telephone_______________________________ How known_____________________________ How known______________________________ Did you complete this application yourself? Yes No If not, who did? _____________

CERTIFICATION: I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. SIGNATURE: ______________________________________________ DATE: _______________

RETURN COMPLETED APPLICATION TO WASH & SPIN: In Person: 2020A Campbellton Rd. SW, Suite W, Atlanta, GA 30311 Via Fax: (404) 756-1660 Via Email: jobs.washnspin@gmail.com
__________________________DO NOT WRITE BELOW THIS LINE_______________________ Interviewed by _____________________________________________ Date _________________ Remarks: