Application for Employment

If you are interested in becoming a member of our team, you may complete and submit this application online.  Please respond to every section of this form. 


Durham, North Carolina

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including, but not limited to, race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis. 

Street Address  



Prior Address (if less than 3 years at current address)  



Contact Information

   *please include  area code


Work Experience Are you presently employed?  Yes  No

Which of the following categories of jobs have you had?   Please check each job category that you've worked at: 

house cleaning    fast food    hotel/motel    janitorial    manufacturing   restaurant    sales  

service  clerical    Other *explain in the comment section below

Please list below your last three employers, starting with your present or last place of employment.  When responding to "Dates Employed" use the  format " mm/yy to mm/yy" as in the example below.  Except for Dates Employed,  you may enter more information than what the space appears to allow for under each heading.

Dates Employed

Name and Address of Employer


Position or Job Title

Briefly describe your job duties

What was your reason for leaving?

(example: 08/07 to 11/09





Education   *Please select the highest level achieved
Eligibility Do you have a current valid driver's license?  Yes  No

Do you have your own vehicle?  Yes  No            Is it insured?   *Yes  No  Not Applicable, I do not have own car.     *We will require proof of  comprehensive liability insurance

Can you provide verification of your legal right to work in the United States?  Yes  No      *We will obtain your Social Security Number at the time of your personal interview and ask for verification of your legal work status and completion of the I-9 form  no later than 3 business days after hire.

Are you able to lift 50 pounds or more?   Yes  No

Would you have difficulty standing, bending or kneeling in connection with performing the necessary cleaning duties?  Yes  No

Have you ever been convicted of a criminal offense?  Yes  No     Due to the security-sensitive nature of the job, all employees are required to be bonded.  As a matter of policy, the company conducts a police background and driving record check on any applicant in consideration of hiring.

Additional Comments If there  is anything you would like to  add, please make your comments in the box below:



In submitting this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal.   I understand that if this application results in a subsequent personal interview for employment that I will be asked to furnish certain references concerning my work history.  I acknowledge that each company is independently owned and operated and that each company is responsible for its own hiring and employment practices.  I understand that prior to employment that the company will conduct any investigation necessary concerning any part of my background related to the position I am seeking, including, but not limited to, the obtaining of a police report and driving record.  I understand and agree that, if employed, I will be responsible for familiarizing myself with all rules and regulations of the company as they presently exist or are later modified and that I will abide by its rules and regulations which I understand are subject to change.  I also understand that no representative of the company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.

I have read, understand and agree with the above.  I do not agree



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Revised: 03/27/12