Job Application: Part Time job cleaning Job at Laundromat

EMPLOYMENT APPLICATION for the Davenport, IA Laundromania:  Required fields are marked with *

Laundromania is an equal opportunity/affirmative action employer. All qualified applicants will be considered with out regard to age, race, color, sex, religion, nationality, marital status, ancestry, citizenship, veteran status, sexual orientation, or physical or mental disability.

*First Name:

*Last Name:

Email (required)

*Date of Birth:

*Street Address:

*City & State:

*Zip Code:

Home Phone:

*Mobile Phone:

*Do you currently have a Driver's License?
YesNo

*Are you a citizen of the United States?
YesNo

If not a citizen, are you prevented from becoming legally employed because of visa or immigration status?
YesNo

*Wage desired:

*How many hours would you like to work?

*Are you looking for Permanent or Seasonal employment?
PermanentSeasonal

*What is your availability?
DaysNightsWeekendsMorningsAfternoonsHolidays

*Are you currently employed?
YesNo

*Highest grade of High School completed:

*High School Name:

Describe Post-High School education or training. If none, enter "none":

*Have you ever operated a cash register?
YesNo

*Current or most recent Employer's Name:

*Dates of Employment:
-

*Supervisor Name:

*Supervisor Phone Number:

*May we contact your supervisor?
YesNo

*Your Job Title:

*Duties & Responsibilities:

*Current or most recent job's wages:

*Reason for leaving current or most recent job:

Prior Job Employer Name:

Prior Job Dates of Employment:
-

Prior Job Supervisor Name:

Prior Job Supervisor Phone Number:

May we contact your Prior Job supervisor?
YesNo

Your Prior Job Title:

Duties & Responsibilities at Prior Job:

Prior Job's wages:

Reason for leaving Prior Job:

I certify that the information in the application is correct to the best of my knowledge.

I understand that in order to be considered for employment, I will need to provide Laundromania with my social security number.

By submitting this application, I hereby authorize all corporations, companies, credit agencies, schools, government agencies, persons, military service, and former employers to release information they may have about me to, Laundromania or its agents and employees, and release all persons or companies from liability or responsibility from doing so. Further, I authorize the procurement of a consumer report, credit check and department of motor vehicle records. I understand that such a report may contain information about my background, character, and personal reputation. I understand that this notice will also apply to any future update reports.

I understand any false answers, statements, or implications made by me on this application or other required documents shall be considered sufficient cause for denial of employment or discharge. Upon termination of my employment for whatever reason, I release this company from all liability for supplying any information concerning my employment to any potential employer. If requested, I will take a post job-offer physical examination and my employment, in the event I receive medical treatment for any condition, including a physical, psychological, emotional, or psychiatric condition that is job-related, I hereby authorize the limited release and exchange of such medical information relating to my condition between the treatment provider and a company-designated physician. I further understand this is an application for employment and no employment contract is being offered. I understand that if I am employed, such employment is for an indefinite period of time and the company may change wages, benefits, and conditions at any time. My employement is at will. No individual with the company is authorized to change the employment-at-will status except an officer of the company, who may do so only in writing. I have read and agree to the above.