Carpe Diem Cleaning, Inc. 902 Pearl Streetdurham, NC27701 (919) 68-CLEAN (682-5326)

Employment Application

Carpe Diem Cleaning, Inc. 902 Pearl StreetDurham, NC27701 (919) 68-CLEAN (682-5326)

Date: ______

Full Name: ______

Social Security Number: ______

Home Phone: ______Cell Phone: ______

Permanent Address:______

City: ______State: ______Zip Code: ______

Driver’s License Number: ______State: ______

Date of Birth: ______

Are you legally authorized to work in the United States? ______

Are you under 18? Yes ______No ______

Have you ever been convicted of a crime? ______

If YES, give date, place, offense, and outcome (Previous convictions do not necessarily disqualify an application from employment) ______

______

Position Desired: ______

How did you hear about this position? ______

List Job skills and experience that apply for this job: ______

______

______

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Availability: (Circle all that apply)

MondayTuesdayWednesday Thursday FridaySaturday

Date Available: ______Desired Salary: ______

You are encouraged to attach a resume or any additional information that qualifies you for the position for which you are applying.

Please List Most Recent Employment First

(1) Employer Name: ______

Street Address: ______

City: ______State:______Zip Code: ______

Job Title: ______

Job Duties: ______

______

From: ______To: ______

Supervisor’s Name: ______Supervisor’s Phone Number: ______

May we contact your employer? ______

(2) Employer Name: ______

Street Address: ______

City: ______State:______Zip Code: ______

Job Title: ______

Job Duties: ______

______

From: ______To: ______

Supervisor’s Name: ______Supervisor’s Phone Number: ______

May we contact your employer? ______

NameAddressPhone

1)______

2)______

I certify that the information contained in this application is correct to the best of my knowledge, and I understand that any misstatement or omission of information is grounds for ending the hiring process or dismissal. I authorize verification of information provided on this application; and authorize references listed above to give all pertinent information; and release all parties from all liability for any damage that my result from furnishing same to Carpe Diem Cleaning, Inc. In consideration for my employment, I agree to conform to the rules and regulations of Carpe Diem Cleaning, Inc. I further agree that either I, or Carpe Diem Cleaning, Inc. may terminate employment with or without cause or with or without prior notice, at any time. Finally, I understand that no representative of the Carpe Diem Cleaning, Inc. other than an Executive Officer has the authority to enter into any agreement for employment for any specific period of time, or to otherwise alter the foregoing.

Carpe Diem Cleaning, Inc is an Equal Employment Opportunity employer. We conduct all employment-related activities without regard to race, color, religion, gender, gender identity, marital status, age, disability, veteran status, sexual orientation, national origin, or other classification protected by applicable State or Federal employment discrimination laws. Carpe Diem Cleaning, Inc., welcomes diversity in the workplace.

Printed Name: ______

Signature: ______Date: ______