New Page 1 Applicant Name

Employment Application

 

Grand Reflection, LLC

7971 Oakridge Dr

Concord Twp, Ohio 44060

 

It is the Policy of Grand Reflection, LLC to provide equal employment opportunities to all applicants and employees without regard to race, color, religion, gender, national origin, age, disability or veteran status.

 

 

                                                 Applicant Information

 

Applicant Name
Address
City/State/Zip
Number of years at this address
Daytime Phone
Evening phone or cell
Social Security Number
Email Address:

 

Emergency Contact

Who should be contacted if you are involved in an emergency?

 

Contact Name
Relationship to you
Address
City/State/Zip
Daytime phone
Alternate or cell

 

Additional Information

 

 

 

Job position applied for
Salary desired per hour

 

Did someone refer you to our company? Yes
No
If yes, list name of person who referred you

 

Have you applied to our company previously? Yes
No
If yes, list date and position applied for

 

Are you 18 years or older? Yes
No


Drivers License Number
State license issued

 

Are you willing to work days and evenings including weekends? Yes
No
If no, please state your availability limitations

 

 

 

If offered employment, when would you be available to begin work?

 

Are you legally eligible for employment in the U.S? Yes
No


Are you able to perform the essential functions of the job position you are applying for, with or without reasonable accommodation?

Yes
No
If no, what reasonable accommodations, if any, would you require?

 

Have you ever been convicted of any crime, including traffic violations? Yes
No
If yes, describe each including dates

 

The existence of a criminal record does not constitute an automatic bar to employment unless relevant to the type of employment.

 

Applicant Skills

 

Check the following skills that you obtain Accounting/Bookkeeping
Filing
Customer Service
Sales
Window Cleaning
Pressure Washing
Gutter Cleaning
Chandelier Cleaning
Deck Refinishing/Restoration
None of the above

List each skill checked above, along with years of experience, and an ability rating of one to five. (1) represents fair ability and (5) represents exceptional expertise.

 

 

Employment History

List your current or most recent employment first.

 

Employer Name
Address
City/State/Zip
Job Duties
Reason for leaving, or if currently employed, reason for wanting to leave
Dates of employment

 

Employer Name
Address
City/State/Zip
Job Duties
Reason for leaving
Dates of employment

 

Employer Name
Address
City/State/Zip
Job Duties
Reason for leaving
Dates of employment

 

 

Education and Training

 

High School Name
High School Address (City/State/Zip)
Last grade completed 9th
10th
11th
12th
Graduated/Diploma
GED


College Name
College Address (City/State/Zip)
Did you receive a degree? Yes
No
Still attending
Plan on returning


List any other training and location (Graduate/Technical/Vocational)

 

List any special achievements, honors or awards

 

 

 

References

 

List any two people who would be willing to provide a reference for you.

Name
Address
City/State/Zip
Daytime Phone
Alternate or cell
Relationship to you (Friend/Relative/Previous Boss/Co-Worker/Etc...)

 

Name
Address
City/State/Zip
Daytime Phone
Alternate or cell
Relationship to you (Friend/Relative/Previous Boss/Co-Worker/Etc...)

 

 

 

Please provide any other information about yourself that you believe should be considered regarding the position(s) you are applying for

 

 

 

Certification

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Grand Reflection, LLC to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its owner, the employment relationship will be entirely voluntary in nature. in other words, with appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer Grand Reflection, LLC will have the same right. Moreover, no agent, representative, or employee of Grand Reflection, LLC except in a specific written contract of employment signed on behalf of the organization by its owner, has the power to alter or vary the voluntary nature of the employment relationship.

 

BY SIGNING/PRINTING/TYPING MY NAME BELOW, I CERTIFY THAT I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

 

Applicant Signature (Print Name)
Date