Lasting Impressions Flooring and Cleaning Services

First Name *

Middle Name *

Last Name *

Address (street address)

Address 2

City

State

ZIP Code

Phone Number

Email *

Date Available*

Social Security Number

Desired Salary($)

Position Applied for:

Are you a citizen of the United States?

YES

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

YES

Have you ever worked for this company?

YES

If so, when?*

From*

End*

Have you ever been convicted of a felony?

YES

If yes, explain:

Education

High School*

High School Address*

From*

End*

Did you graduate?

YES

Diploma *

College*

College Address*

From*

End*

Did you graduate?

YES

Degree *

Other*

Other Address*

From*

End*

Did you graduate?

YES

Degree *

References

Please list three professional references

Reference 1

Full Name:

Relationship:

Company:

Phone:

Address:

Reference 2

Full Name:

Relationship:

Company:

Phone:

Address:

Reference 3

Full Name:

Relationship:

Company:

Phone:

Address:

Previous Employment

Previous Employment 1

Previous Employer:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From*

To*

Reason for leaving:

May we contact your previous supervisor for a reference?

YES

Previous Employment 2 (optional)

Previous Employer:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From*

To*

Reason for leaving:

May we contact your previous supervisor for a reference?

YES

Previous Employment 3 (optional)

Previous Employer:

Phone:

Address:

Supervisor:

Job Title:

Starting Salary: $

Ending Salary: $

Responsibilities:

From*

To*

Reason for leaving:

May we contact your previous supervisor for a reference?

YES

Millitary Service

Branch:

From*

To*

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

Disclaimer

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release

I certify that my answers are true and complete to the best of my knowledge.

Employment application

Education

References

Previous Employment

Millitary Service

Disclaimer