"*" indicates required fields 1Start Application2Work Requirements3Contact Info4Additional Info5Education6Employment History7Additional Qualifications8Refrences9Affirmative Action10Finalize We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.WE ARE AN EQUAL OPPORTUNITY EMPLOYERPosition(s) Applied For*Job LocationDesired wage or salary rangeHow did you learn about us?* Referral Social Media Advertisement Employment Agency Job Fair Walk-In Other If you selected "Other" above...If you selected "Referral" above please enter the referrals name Safari Work RequirementsI am capable of performing the following job functions:Job Functions* Able to lift 40 lbs. Able to maintain physical activity for 2 - 4 hour intervals. Able to rotate upper body 180 degrees (90 degrees left 90 degrees right). Able to use stairs. Flexible in all major joints. Able to use both arms over head. Able to maintain balance while looking up. Can you Perform Essential functions* YES NO Need to Discuss with Interviewer Can you with or without reasonable accommodations perform the essential functions of this job? If you have any questions about the functions of the job, please ask the interviewer before answering this question. Name and AddressFull Name* First Middle Last Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneCell PhoneEmail Address* Additional InformationAre you 18 years or older?* Yes No Have you ever filed an application with us before? Yes No If you selected "Yes" above, give date...Have you ever been employed with us before? Yes No If you selected "Yes" above, give date and reason for leaving...May we contact your present employer? Yes No Are you currently subject to a non-compete, confidentiality, non-disclosure, employment agreement or any offer agreement potentially restricting the scope of your work with a future employer? Yes No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes No Proof of citizenship or immigration status will be required upon employmentCan you with or without reasonable accommodations perform the essential functions of this job? Yes No If you have any questions about the functions of the job, please ask the interviewer before answering this question.On what date would you be available for work? MM slash DD slash YYYY Are you available to work... Full Time Part Time Shift Work Temporary Are you currently on "lay-off" status and subject to recall? Yes No Can you travel if a job required it? Yes No Have you been convicted of a crime other than a minor traffic infraction? Yes No Conviction will not necessarily disqualify an applicant from employment.If you selected "Yes" above, please explain... EducationEducationHigh School | College | Years Completed | Diploma/DegreeWere you ever in the U.S. Military or Government Service? Yes No If you select "Yes" above, what military branch, agency and final rank?If you select "Yes" above, dates of duty or service....From | To Employment ExperienceStart with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.EmployerSupervisorHrs/weekStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Telephone Number(s)Job TitleReason for LeavingWork PerformedEmployerSupervisorHrs/weekStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Telephone Number(s)Job TitleReason for LeavingWork PerformedEmployerSupervisorHrs/weekStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Telephone Number(s)Job TitleReason for LeavingWork PerformedEmployerSupervisorHrs/weekStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Telephone Number(s)Job TitleReason for LeavingWork PerformedList professional, trade, business or civic activities and offices held.You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status. Additional Skill InformationPlease list any job experience or training related to the cleaning or service industry.Other Skills/QualificationsSummarize special job-related skills and qualifications acquired from employment or other experience. References such as previous supervisor or co-worker who can provide professional referencesNamePhoneNamePhoneNamePhone Affirmative Action Data RecordPlease note: YOUR COOPERATION IS VOLUNTARY. INCLUSION OR EXCLUSION OF ANY DATA WILL NOT AFFECT ANY EMPLOYMENT DECISION. Employees are treated during employment without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. As an employer with an Affirmative Action Program, we comply with government regulations, including Affirmative Action responsibilities where they apply. The purpose for this Data Record is to comply with government record keeping, reporting, and other legal requirements. Periodic reports are made to the government on the following information. The completion of the Data Record is optional. If you choose to volunteer the requested information please note that all Data Records are kept in a Confidential File and are not a part of your Application for Employment or Personnel file. Gender Male Female Other Ethnicity White Black / African American Hispanic/Latino Asian Native / Hawaiian / Pacific Islander Native American / Alaskan Native Two Or More Races Other Applicant's StatementI specifically authorize Safari Contract Cleaners, and those acting on behalf of Safari Contract Cleaners, to investigate and/or make inquiry into my background as may be necessary in arriving at an employment decision, including, but not limited to, a criminal background check, a consumer reporting agency report, an MVR (motor vehicle report) and workman’s compensation activity report. I release Safari Contract Cleaners from any liability, including a potential claim for defamation, related to the completion or undertaking of my pre-employment background check. This application for employment shall be considered active for a period of time not to exceed 6 months. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or inter-view(s) may result in discharge. If employed, I agree to abide by all policies, rules and procedures of the Employer. I also understand that I may be required to take a drug test or participate in a random drug pool as a condition of employment. I hereby authorize the use of photocopies of this section of the application for employment for acceptance by all persons and parties as an original for the release of any and all information that is relevant to the consideration of the application of employment. I agree to release all such persons and parties from any claim or liability for providing such information to the company. Signature of Applicant*Please enter your full name to electronically sign this application.Date* MM slash DD slash YYYY Date Of Birth* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
