Naturally Clean Lafayette LLC
Employment Application

1. Applicant Information

Full Name:
Date:
Address:
City:
State:
Zip:
Phone:
Email:
Date Available:
Desired Pay:
Position Applied For:

Are you a citizen of the United States? Yes No

If no, are you authorized to work in the U.S.? Yes No

Have you ever worked for this company? Yes No If yes, when?

2. Education

High School:
Address:
Did you graduate?	Yes No
College:
Address:
Did you graduate?	Yes No Degree:

3. References

Reference 1
Name:
Relationship:
Company:
Phone:
Email:
Reference 2
Name:
Relationship:
Company:
Phone:
Email:
Reference 3
Name:
Relationship:
Company:
Phone:
Email:

4. Previous Employment

Company:
Phone:
Supervisor:
Job Title:
Starting Pay:
Ending Pay:
Responsibilities:
From:
To:
Reason for Leaving:
May we contact your previous supervisor?	Yes No

5. Availability

What days/hours are you available to work?

Are you willing to work evenings or weekends? Yes No

6. Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature (type your name):
Date: