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Personal Information

Availability

Position Applying For

Available Start Date

Currently Employed?

Yes

Name

First Name*

Last Name*

Middle Name

Contact

Home Phone No

Cell No*

Email*

Address

Street

Apt.#

City / State*

Zip Code*

Emergency Contact

In case of emergency, please list contact and phone number.

Contact Name

Phone Number

Relationship

Referral / Relation

If related to anyone in our company, state name and function.

Name

Function

Referred By

Former Employers

(List below your last three employers, starting with the most recent)

Employer 1

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

Employer 2

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

Employer 3

Employer Name and Address

Supervisor’s Name and Phone Number

Position Title

Reason for Leaving

Joining Date (month and year)

Leaving Date (month and year)

References

(List below the names of three persons, not related to you, whom you have known for at least two years)

Reference 1

Name

Address/Phone Number

Relationship

Years Acquainted

Reference 2

Name

Address/Phone Number

Relationship

Years Acquainted

Reference 3

Name

Address/Phone Number

Relationship

Years Acquainted

Respond to the following questions:

Are you eligible to work in the U.S.?*

Yes

Do you have a valid driver’s license? (Attach H-6 if possible)*

Yes

Do you have a CDL?*

Yes

We are a 100% drug-free workplace under California DMV regulations. Will this create a challenge for you?*

Yes

Cannon Pacific Services, Inc., dba Pacific Sweeping is a drug free environment. All applicants are drug tested throughout employment. Any false statements made on this application will be grounds for termination.

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Careers with Pacific Sweeping

Personal Information

Availability

Name

Contact

Address

Emergency Contact

Referral / Relation

Former Employers

Employer 1

Employer 2

Employer 3

References

Reference 1

Reference 2

Reference 3

Respond to the following questions: