APPLICATION FOR EMPLOYMENT

TODAYS DATE: POSITION APPLIED FOR: FIRST CITY CELL PHONE E-MAIL

TIDY CLEAN
Full Time / Part Time
MIDDLE ZIP

PERSONAL INFORMATION
NAME: LAST ADDRESS PERMANENT ADDRESS HOME PHONE

BACKGROUND CHECK All candidates must pass a background check prior to being selected for an interview and accepting employment with TIDY CLEAN. Should you be selected for an interview, your formal signature below is our authorization to conduct a background check, in order to expedite the process of scheduling your interview.
CANDIDATE AUTHORIZATION FOR BACKGROUND CHECK: Your birth date is required in order to process a background check.

Date of Birth: ____/_____/_____

Month / Day / Year

(Signature)_________________________ (PRINT FULL LEGAL NAME)________________________________________

HOW DID YOU LEARN ABOUT US?
(please name as applicable) WEBSITE REFERED BY FRIEND______________________________ MN WORKFORCE REFERRED BY A CURRENT EMPLOYEE ______________ PHONE DIRECTORY NEWSPAPER AD __________________________________

PASSING BY:_________________________ OTHER:_____________________________

EMPLOYMENT PREFERENCES
HAVE YOU APPLIED WITH TIDY CLEAN BEFORE IF YES: DATE OF APPLICATION: __________________________________ DD/MM/YY) POSITION APPLIED FOR:_________________________________ P/T

YES

/ NO

F/T

WHEN ARE YOU ABLE TO START WORK? ____ / _____ / _____ (DD /MM /YY)

DESIRED SALARY $ _________, GROSS PER HOUR

MONDAY FRIDAY DESIRED AMOUNT OF HOURS PER WEEK ______

SATURDAY/SUNDAY DESIRED AMOUNT OF HOURS PER WEEKEND __________

FROM/ TO

EDUCATION
TYPE

NAME

LOCATION

AREA OF STUDY

GRADUATION DATE

GRAMMAR SCHOOL HIGH SCHOOL COLLEGE TRADE OR BUSINESS SCHOOL

GENERAL
STUDIES, RESEARCH:

US MILITARY SERVICES

RANK

MEMBER OF NATIONAL GUARDS/ RESERVES?

APPLICATION FOR EMPLOYMENT

TIDY CLEAN
Employment Application/HR/ Page 1 of 2

FORMER EMPLOYERS- starting with most recent or current

FROM TO COMPANY NAME ADDRESS POSITION SALARY REASON FOR LEAVING

FROM TO

COMPANY NAME

ADDRESS

POSITION

SALARY

REASON FOR LEAVING

FROM TO

COMPANY NAME

ADDRESS

POSITION

SALARY

REASON FOR LEAVING

FROM TO

COMPANY NAME

ADDRESS

POSITION

SALARY

REASON FOR LEAVING

REFERENCES Persons not related to you who have know you for at least a year NAME ADDRESS HOW ARE YOU KNOWN TO EACH OTHER NAME NAME ADDRESS ADDRESS HOW ARE YOU KNOWN TO EACH OTHER HOW ARE YOU KNOWN TO EACH OTHER

YEARS KNOWN YEARS KNOWN YEARS KNOWN

DISCLOSURE AUTHORIZATION

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein with the referees and employers listed, to provide any pertinent information they may have concerning my association with them. I understand that this application does not allow TIDY CLEAN access to any of my personal data such as medical records, commonly protected by my legal confidentiality rights.

(Signed)_________________________________(PRINT NAME)_____________________________

Please return your completed application:

By Mail: Human Resources TIDY CLEAN 500 Patterson Ave., Ste 200 Mankato, MN 56001 In person: Hand it to the office staff (8a-5p M-F)

Thank you for your interest in Employment with TIDY

=

CLEAN

Employment Application/HR/ Page 2 of 2