EMPLOYMENT

Please complete the entire application.

  1. Employer Information

Michigan Maid Cleaning Authority, LLC

11770 Newburgh rd, Suite B, Livonia , Mi 48150

734-366-8676

It is the policy of Michigan Maid Cleaning Authority, LLC to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as race, color, religion, gender, national origin, age, disability or veteran status.

  1. Applicant Information

Applicant Full Name: ___________________________________________

Home Address:           ___________________________________________

City/State/ZIP:            ___________________________________________

Number of years at this address:        _________

Daytime phone:____________________Evening phone:     ____________________

Mobile phone: ____________________

Social Security Number:         ___________________________

Driver’s License (State/Number):       ___________________________

  1. Emergency Contact

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

Contact Name:            ___________________________________________

Relationship to you:    ___________________________________________

Address:          ___________________________________________

City/State/ZIP:            ___________________________________________

Daytime phone:____________________Evening phone:     ____________________

4.Job Position Applied For:  Cleaning Team Member

5.Are you at least 18 years old?______ Yes  ______ No                                                            6.How will you get to work? _____________________________________                                              7.Are you willing to work any shift, including nights and weekends? _____ Yes _____ NoIf no, please state any limitations:________________________________________________

  1. If applicable, are you available to work overtime? _____ Yes _____ No
  2. If you are offered employment, when would you be available to begin work?

____________________________________

  1. If hired, are you able to submit proof that you are legally eligible for

employment in the United States? _____ Yes            _____ No

  1. Are you able to perform the essential functions of the job position you seek with

or without reasonable accommodation?______ Yes ______ No

What reasonable accommodation, if any, would you request?

________________________________________________

  1. Have you ever been convicted of a felony or misdemeanor?

______ Yes, I was convicted of ______________________________ on ____________ (date) in _________________ (city), _______________ (state)

______ No

THE EXISTENCE OF A CRIMINAL RECORD DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT UNLESS RELEVANT TO THE TYPE OF EMPLOYMENT.

  1. Applicant’s Skills

List any skills that may be useful for the job you are seeking. Enter the number of years of experience, and circle the number which corresponds to your ability for each particular skill. (One represents poor ability, while five represents exceptional ability.)

Ability or Skill________________________________________________________________________

Years of Experience__________________________________________________________________

  1. Applicant Employment History

List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. If additional space is needed, continue on the back page of this application.

Employer Name:         ___________________________________________

Supervisor Name:       ___________________________________________

Address:          ___________________________________________

City/State/ZIP:            ___________________________________________

Job Duties:      ___________________________________________

Reason for Leaving:    ___________________________________________

Dates of Employment (Month/Year): _____________________________

Employer Name:         ___________________________________________

Supervisor Name:       ___________________________________________

Address:          ___________________________________________

City/State/ZIP:            ___________________________________________

Job Duties:      ___________________________________________

Reason for Leaving:    ___________________________________________

Dates of Employment (Month/Year): _____________________________

Employer Name:         ___________________________________________

Supervisor Name:       ___________________________________________

Address:          ___________________________________________

City/State/ZIP:            ___________________________________________

Job Duties:      ___________________________________________

Reason for Leaving:    ___________________________________________

Dates of Employment (Month/Year): _____________________________

  1. Applicant’s Education and Training

College/University Name and Address_______________________________________________

______________________________________________________________________________________

Did you receive a degree?______ Yes _____ No      If yes, degree(s) received: ___________

High School/GED Name and Address

____________________________________________________________

Did you receive a degree?______ Yes           _____ No

Other Training (graduate, technical, vocational):

_______________________________________________________________________________________

Please indicate any current professional licenses or certifications that you hold:

________________________________________________________________________________________

Awards, Honors, Special Achievements:

_________________________________________________________________________________________

  1. References

List any two non-relatives who would be willing to provide a reference for you.

Name:  ________________________________________________

Address:          _________________________________________

City/State/ZIP:            ___________________________________

Telephone:       ________________________________________

Relationship:   ________________________________________

Name:  ________________________________________________

Address:          _________________________________________

City/State/ZIP:            ___________________________________

Telephone:       _________________________________________

Relationship:   _________________________________________

  1. Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

_________________________________________________________________________________

_________________________________________________________________________________

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 Michigan Maid Cleaning Authority, 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 “at-will.” In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. 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 will have the right. Moreover, no agent, representative, or employee of Michigan Maid Cleaning Authority, 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.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

____________________________________            _______________

APPLICANT SIGNATURE                                 DATE

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