All information here will be in strict confidence.

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital, or veteran status, the presence or a non-job-related medical condition or handicap, or any other legally protected status.

Phone

Last Name

First Name

Address

City

State

Zip

Are you under 18 years of age?

Earnings Expected

Firm

Firm Address

Type of business

Title

Employed From

Employed To

Salary

Nature of Work

Supervisory Responsibility

Immediate Supervisor

What do you most like about your job

What do you least enjoy

Reason you left your job

Other positions held:

Company	Type of Work	Date Began	Date Left

Have you had any cleaning or janitorial experience?

YesNo

If so, describe

Physical Data:

Condition of Health:

What physical handicaps or limitations do you have that would affect your job performance?

Have you been convicted of a felony within the last 7 years?

YesNo

(Conviction will not necessarily disqualify applicant for employment.) If yes, please explain:

What days of the week are you available?

What hours are you available?

Do you have good transportation?

YesNo

List Two References

Name	Relationship	Phone

I agree, inconsideration of my employment, to conform to the rules and policies of the
employer, and that my employment can be terminated, with or without cause, at any time,
at the option of either the employer or myself. I understand that no representitive of the
employer, other than the personnel manager or president has any authority to enter into
any agreement for employment for any specific period of time, or to make any other agreement.

I give my written consent for Sunny Maids to obtain a copy of my driving record at company expense, should such record be requested for employment purposes. In order to obtain this information I am releasing the following information:

Date of Birth:	Driver License Number:	Signature

SUNNY MAIDS INC. IS A NON-SMOKING BUSINESS
NOTE: If hired, you will need to present your driver's license and social security card.

Bismarck/Mandan

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