![](data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAABD4AAAAuCAIAAABPrE4KAAAACXBIWXMAABYlAAAWJQFJUiTwAAAA/klEQVR42u3ZwQkAMAgEQQ3pv+VLFQGFmRIOP4tVAAAA43USKwAAAMMdEwAAANIFAABAugAAANIFAABAugAAAEgXAABAugAAAEgXAAAA6QIAAEgXAAAA6QIAAEgXAAAA6QIAACBdAAAA6QIAACBdAAAApAsAACBdAAAApAsAAIB0AQAApAsAAIB0AQAApAsAAIB0AQAAkC4AAIB0AQAAkC4AAADSBQAAkC4AAADSBQAAkC4AAADSBQAAQLoAAADSBQAAQLoAAABIFwAAQLoAAABIFwAAAOkCAABIFwAAAOkCAABIFwAAgDGuCQBgoO42wiJJ3CEO7DdfFwAAYIEHOGwJWXYl4igAAAAASUVORK5CYII=)
NEWLYFORMEDCLEANINGCOMPANY
214RAILROADSTREET
MUNCY,PA.17756
EmploymentApplicationApplicantTelephone:________________________
DATE:_______________SocialSecurityNumber:_____________________
YourName:_______________________________________________________________________________________
Last First Middle
Address: AREYOULEGALLYELIGIBLEFOREMPLOYMENTINTHEUSA?
______________________________ ____Yes ___No (Ifyes,verification(ID)willberequired)
_______________________________ IAMSEEKNGAPERMANENTPOSITION:____Yes ____No
________________________________ IFNECESSARYFORTHEJOBIAMABLETO:
Work(WhatShifts)? __________________
Workovertime?__________________
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Areyouover18yearsofage? ____Yes ___No
Ifyouareunder18yearsofage,canyouproviderequiredproofofeligibilitytowork ___Yes ___No
Education:YrsComplete: FieldofStudy:
HighSchool:___________________________ ___________________ ______________ _____________
Buisness/Technical:________________________________________ ______________ _____________
College/University:________________________________________ ______________ _____________
Other:__________________________________________________ ______________ _____________
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Haveyoueverbeenconvictedofanycriminaloffenseotherthanminortrafficviolations?____Yes_____No
Ifsopleaseexplain:_________________________________________________________________________________
Acriminalconvictionwillbeconsideredonlyinrelationtothejobforwhichyou
areapplying.Seriousnessandnatureof
theoffense,timeelapsedandrehabilitationwillbetakenintoaccount.
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐