Employment Application for Arkansas

Personal Information

"*" indicates a required field.

*Name (First, Middle, and Last)

*Email

*Mailing Address (include City, State, & Zip)

*Cell Phone
Type CellHome

Other Phone
Type NoneCellHome

Are you legal to work in the U.S.? YesNo

Have you been convicted of a felony? YesNo

If yes, please explain:

Please include any and all dates and charges. Clempire LLC does not automatically exclude applicants based on upon criminal history without first reviewing the details. Failure to fully and accurately answer may result in elimination from consideration or termination from employment, if discovered later.

Can you pass a drug test? YesNo

Social Security Number:

Date of Birth:

Do you have a valid driver's license? YesNo
Driver's license number:
State Issued:

Getting to know you more...

This section will help us get to know you better, because we care about who is on our team!

1. Where did you hear about Clempire?

(0 of 200 characters)

2. Describe the perfect day off:

(0 of 200 characters)

3. How would you describe your living room and/or bedroom?

(0 of 200 characters)

4. If you had a boat, what would you name it?

(0 of 200 characters)

5. What’s the first thing that comes to mind when I say, “cleaning”?

(0 of 200 characters)

6. Describe your personality:

(0 of 200 characters)

7. What’s the last book you read? Describe it:

(0 of 200 characters)

8. What are you talented at?

(0 of 200 characters)

9. What are your family (or friends) like?

(0 of 200 characters)

10. Why do you want to work here?

(0 of 200 characters)

Employment Desired

Position desired:

Preferred schedule: Any AvailablePart TimeFull Time

Potential start date:

Desired wages:

Availability

Mon:   NoneAnyDayEveningOvernight
Tues:   NoneAnyDayEveningOvernight
Wed:   NoneAnyDayEveningOvernight
Thu:   NoneAnyDayEveningOvernight
Frid:   NoneAnyDayEveningOvernight
Sat:   NoneAnyDayEveningOvernight
Sun:   NoneAnyDayEveningOvernight
Availablility comments:

Education or Military Service

Name and Location of High School:

Did you graduate? YesNo

Have you served in the military? YesNo
If so, please list the branch, your rank, and type of discharge:

List any colleges, courses, training, or certificates:

(0 of 200 characters)

Employment History:

Current/Previous Employer:

Are you currently employed? YesNo
May we contact your current employer? YesNoN/A

Company, Address, Supervisor's Name, and Phone.

Wage:
Position:
Reason for leaving:
Date Started (Month & year):
Date Left (Month & year):

Second Employer:

Company, Address, Supervisor's Name, and Phone.

Wage:
Position:
Reason for leaving:
Date Started (Month & year):
Date Left (Month & year):

List Any Cleaning Experience:

List any cleaning duties for which you have been trained. (examples: Residential cleaning, Office Cleaning, Cleaning: Carpets, Windows, Floors, Buffing, Strip & Wax, Power Washing, Construction Final Clean, etc.)

Personal References

*Reference #1 (Name, address, and phone):

How do you know this person?
Number of years known:

*Reference #2 (Name, address, and phone):

How do you know this person?
Number of years known:

*Reference #3 (Name, address, and phone):

How do you know this person?
Number of years known:

Additional Information

Without using the words "hard-working" or "dependable", what separates you from everyone else? Also, include any other comments that you feel we need to know to be able to better evaluate your application.

(0 of 200 characters)

Employment Application Authorization

By typing my name below as an electronic signature I certify that I am the person that is stated on this employment application, and that the facts contained in this employment application are true and complete to the best of my knowledge; I also certify I understand that, if employed, falsified statements on this employment application shall be grounds for immediate dismissal.
I authorize investigation of all statements contained herein, and I explicitly authorize the references and employers listed above to release to you any and all information concerning my employment, and any pertinent information they may have, personal or otherwise, and release the company and individuals from all liability for any damage that may result from utilization of such information.
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), by HIPAA, and other relevant federal and state laws.

*Signature:
*Date: