Name (First, Middle, Last)

Email Address

Street Address

City, State, Zip

Home Phone

Do you have a Social Security Number? (YES/NO) Do you have a Social Security Number? (YES/NO) YES NO

Are you eligible to work in the United States? (YES/NO) Are you eligible to work in the United States? (YES/NO) YES NO

Are you 18 years of age or older? (YES/NO) Are you 18 years of age or older? (YES/NO) YES NO

If you are under 18, what is your current age?

Have you ever been employed by Crystal Image Cleaning, Inc.? (YES/NO) Have you ever been employed by Crystal Image Cleaning, Inc.? (YES/NO) YES NO

If you answered YES to the above question, give dates of employment and reason for leaving:

Are you related to any current Crystal Image Cleaning, Inc. employee? Are you related to any current Crystal Image Cleaning, Inc. employee? YES NO

If you answered YES to the above question, give their name and relationship to you:

If required for position, do you have a valid driver's license? If required for position, do you have a valid driver's license? YES NO

How did you learn about this employment opportunity at Crystal Image Cleaning, Inc.?

Highest Level of Education Highest Level of EducationHigh SchoolCollegeG.E.D.

Name of School

City and State of School

Did you graduate? Did you graduate? YES NO

If you answered YES give date of graduation:

If you answered NO to the above question, give the number of years left to graduate:

If College, What Degree Was Received?

Skills: Please list any skills relevant to this position.

WORK EXPERIENCE: Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same company, detail each position seperately. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Please note: Crystal Image Cleaning, Inc. reserves the right to contact all current and former employers for reference information.

Job 1: Organization Name and Address

Job 1: Dates Employed (most recent position): From/To

Job 1: Full Time/Part Time? Job 1: Full Time/Part Time? FULL-TIME PART-TIME

Job 1: Position

JobOneStartingSalary

Job 1: Ending Salary

Job 1: Supervisor's Name, Title and Phone Number

Job 1: Other Reference Name, Title and Phone Number

Job 1: If considered for a position, may Crystal Image Cleaning, Inc. contact your current references? Job 1: If considered for a position, may Crystal Image Cleaning, Inc. contact your current references? YES NO

Job 1: Primary duties

Job 1: Reason for Leaving

Job 2: Organization Name and Address

Job 2: Dates Employed (most recent position): From/To

Job 2: Full Time/Part Time? Job 2: Full Time/Part Time? FULL-TIME PART-TIME

Job 2: Position

Job 2: Starting Salary

Job 2: Ending Salary

Job 2: Supervisor's Name, Title and Phone Number

Job 2: Other Reference Name, Title and Phone Number

Job 2: If considered for a position, may Crystal Image Cleaning, Inc. contact your current references? Job 2: If considered for a position, may Crystal Image Cleaning, Inc. contact your current references? YES NO

Job 2: Primary duties

Job 2: Reason for Leaving

Other things you would like us to know