Employment Application
Employment Application
Employment Application
Mission Linen Supply is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable state or federal civil rights laws.
LAUNDRY TECHNICIAN
DATE AVAILABLE TO START
NOW
PERSONAL INFORMATION
LAST NAME FIRST NAME M. INITIAL HOME PHONE
WILSON
PRESENT STREET ADDRESS
KELLY
CITY
L.
STATE
916-204-6340
ZIP CODE
ROSEVILLE
CA.
95747
EDUCATION
NAME OF SCHOOL AND ADDRESS GRADUATED? # YEARS COURSE OR MAJOR GPA
GEN. ED
2.5
Exp. Date:
What business-related machines or equipment can you operate? (Include computer and software):
Extracurricular Activities (You may omit those which indicate your race, color, religion, sex, national origin, ancestry, age, or the existence of a disability):
916-344-5222
AVG. # OF HOURS PER WEEK YEARLY
01-2007
03-2010
$10.00
$10.69 AL SALOMON
40 HOURS
POSITION(S) HELD:
HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:
LAID-OFF
COMPANY NO. 2 ADDRESS TELEPHONE NUMBER
ST. ANTONS
EMPLOYED (Month and Year) FROM TO
916-444-9897
AVG. # OF HOURS PER WEEK YEARLY
03-2006
12-2006
$10.00
40 HOURS
POSITION(S) HELD:
HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:
CLEANED COMMON AREA'S, VACANT UNITS AND GROUNDS.
YES
NO
LAID-OFF
COMPANY NO. 3 ADDRESS TELEPHONE NUMBER
530-753-5910
AVG. # OF HOURS PER WEEK YEARLY
11-2004
03-2006
$10.00
40 HOURS
POSITION(S) HELD:
HOUSEKEEPER
PLEASE DESCRIBE ALL SIGNIFICANT DUTIES:
LAID-OFF
Employment Application Page 2
PLEASE IDENTIFY AND EXPLAIN ALL PERIODS OF UNEMPLOYMENT IN THE LAST FIVE YEARS:
Please list any job-related professional, trade, business, or civic activities, organizations, and associations (you may omit those which indicate race, color, religion, national origin, ancestry, sex, age, or the existence of a disability): NONE
PLEASE PROVIDE THE NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF AT LEAST TWO PROFESSIONAL REFERENCES WHO ARE NOT RELATED TO YOU: NAME ADDRESS TELEPHONE NUMBER
JANIE BORGMAN
NAME
ADDRESS
916-344-5222
TELEPHONE NUMBER
TRENT DODGE
NAME
ADDRESS
530-681-0513
TELEPHONE NUMBER
PATTY LUTZ
NAME
ADDRESS
530-368-9146
TELEPHONE NUMBER
GENERAL INFORMATION
PLEASE NOTE: CERTAIN POSITIONS MAY BE REQUIRED TO COMPLETE A SUCCESSFUL BACKGROUND CHECK HAVE YOU EVER APPLIED FOR A POSITION WITH OR WORKED FOR THIS COMPANY BEFORE? IF YES, SPECIFY DATES: FROM TO ARE YOU RELATED TO OR KNOW SOMEONE EMPLOYED AT MISSION LINEN SUPPLY? IF YES, PLEASE LIST NAMES:
YES
NO
YES
NO
ARE YOU A VETERAN OF THE UNITED STATES MILITARY SERVICE? IF YES, PLEASE STATE BRANCH OF SERVICE:
YES
NO
HAVE YOU BEEN CONVICTED OF A FELONY OR MISDEMEANOR WITHIN THE LAST SEVEN YEARS? YES
NO
(NOTE: Please exclude traffic violations: misdemeanor convictions for marijuana-related offenses more than two years old; convictions that have been sealed, expunged, or legally eradicated; and misdemeanor convictions for which probation was successfully completed or otherwise discharged and the case was judicially dismissed. A conviction is not an automatic bar to employment. Each case will be considered on its own merits.).
IF YES, PLEASE EXPLAIN AND STATE THE CHARGE, THE COURT, THE DATE OF THE CONVICTION, AND THE DISPOSITION OF THE CASE:
I hereby certify that the information contained in this application form is true and correct to the best of my knowledge and agree to have any of the statements checked by Mission Linen Supply unless I have indicated to the contrary. I authorize the references listed above, as well as all other individuals whom Mission Linen Supply contacts, to provide any and all information concerning my previous employment and any other pertinent information that they may have. Furthermore, I release all parties and persons from any and all liability for any damages that may result from furnishing such information to Mission Linen Supply as well as from any use or disclosure of such information or any of its agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application may result in my failure to receive an offer or, if I am hired, my immediate dismissal from employment upon discovery. In consideration of my employment, I agree to conform to the rules and standards of Mission Linen Supply. I further understand my employment is an at-will relationship that either party may terminate for any reason. I further understand that this policy cannot be changed except in writing and then only when signed by an authorized representative of the company. I also understand that all offers of employment are conditioned on the Company's receipt of satisfactory responses to reference requests, the provision of satisfactory proof of an applicant's identity and legal authority to work in the United States, and upon acceptable results of a pre-employment drug screen and background check. For certain positions offers of employment are also conditioned on the satisfactory completion of a post-offer medical examination. SIGNATURE OF APPLICANT ____________________________________________________ DATE ________________________
MALE
FEMALE
TODAYS DATE:
10-19-2010
LAUNDRY TECHNICIAN
Race/Ethnic Group: Native American Indian Black / African American Asian Pacific Islander Hispanic/Latino White Other (Please specify) Two or more races
NOTIFICATION TO APPLICANT OR EMPLOYEE THAT A CONSUMER REPORT MAY BE OBTAINED In compliance with the Federal Fair Credit Reporting Act (15 USC 1681 et seq) and the California Consumer Credit Reporting Agencies Act (Civil Code Section 1786, as amended September 2002) this notice is to inform you that Mission Linen Supply may obtain a consumer report, investigative consumer report, or other investigative reports in connection with your application for employment and for other employment-related reasons, including investigations of character, general reputation, personal characteristics and mode of living. This report is being compiled by SafeCare Information Services, 315 Meigs Rd. Suite H, Santa Barbara, CA 93109, Phone: 805-8841022. You are entitled to receive a copy of any consumer report, investigative consumer report, or other investigative report obtained as a result of your signed authorization within three (3) business days or its receipt by the employer from a Credit Reporting Agency (CRA). You must check the box below and provide your mailing address in order to receive a copy. You are entitled to receive a copy of any background reports based on a public records search including, but not limited to, records of criminal or civil court proceedings, bankruptcy proceedings, or other similar records. I hereby waive my right to receive copies of any and all reports that contain consumer and/or investigative information about me and are obtained by the Employer in connection with this Application for Employment. I hereby request copies of any and all reports that contain consumer and/or investigative information about me and are obtained by the Employer in connection with this Application for Employment.
Applicants address to which copies of consumer reports and other investigative reports should be mailed: