Employment Opportunities

Employer's Name *

Name of Supervisor *

Employer's Address *

Line 1

Line 2

City

State

Zip Code

Country

Employer's Email *

Employer's Phone Number *

Position Held *

Duties *

Start Date - End Date (mm/dd/yyyy - mm/dd/yyyy) *

May we contact this employer? *

Yes No

If NO, reason why not *

Employer's Name *

Name of Supervisor *

Employer's Address *

Line 1

Line 2

City

State

Zip Code

Country

Employer's Email *

Employer's Phone Number *

Position Held *

Duties *

Start Date - End Date (mm/dd/yyyy - mm/dd/yyyy) *

May we contact this employer? *

Yes No

If NO, reason why not *

REFERENCES

Please provide two references. We do not consider or interview anyone who cannot provide 2 references (work, education or church related). NO FAMILY MEMBERS.

I hereby state that all information provided is accurate and may be verified by WNY Regional Cleaning Services®. I agree that I may be discharged if at anytime it is found that I falsified or willfully omitted any material in the information provided on this application form and related documents. WNY Regional Cleaning Services® may contact my former employers. All references are hereby authorized to release all information which they may have relevant to my employment with them. I hereby release WNY Regional Cleaning Services® , its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information provided by such references. I agree that I will follow all WNY Regional Cleaning Services® policies, rules, and procedures. I understand that WNY Regional Cleaning Services® reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime. I agree to make myself available for random drug testing. I have never been convicted of a felony and I have no criminal charges pending against me.

Type Signature *

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Employment Application Form