Application for Employment

There are three ways to submit an application for Atlantic Coast Cleaning:

To Submit Application: STEP 1 STEP 2
By Physical Mail Download, fill out and print the form. Mail it to:

P.O. Box 41485
Raleigh, NC 27629
By E-mail Download, fill out and save the application file to your computer. Email the PDF file to:

jcs@atlanticcoastcleaning.com.
By Online Submission Complete the form below When finished click submit.



Today's Date:
Last Name: First Name: Middle Name:
Soc. Sec. No. (Required):
Address 1: Address 2:
City: Zip:
Phone Number: Alternate Phone Number:
I am applying for a job as:
To Work: Full Time Part Time Temporary
Hours Available:
Days Available: Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Expected Salary:


PREVIOUS EMPLOYMENT

Company 1:
From: To: (MO/YEAR)
Company Name: Company Address:
Salary: Title:
Duties Performed:
Supervisor's Name:
Reason For Leaving:  
Company 2:
From: To: (MO/YEAR)
Company Name: Company Address:
Salary: Title:
Duties Performed:
Supervisor's Name:
Reason For Leaving:  
Company 3:
From: To: (MO/YEAR)
Company Name: Company Address:
Salary: Title:
Duties Performed:
Supervisor's Name:
Reason For Leaving:  
Are you currently Employed? Yes No
May we contact your current employer? Yes No


EDUCATION

High School:
Name: Location: Course Taken:
Last Year Completed: Graduation Date:
College:
Name: Location: Course Taken:
Last Year Completed: Graduation Date:
Other:
Name: Location: Course Taken:
Last Year Completed: Graduation Date:
List any handicaps, health problems or prior work injuries that should be considered in job placement: 
Date of Birth if Under 18:
What prompted you to seek employment at Atlantic Coast Cleaning: 
Where you ever employed by Atlantic Coast Cleaning? Yes No
If yes, when?
List any relatives (and relationship) employed by Atlantic Coast Cleaning: 
Have you ever been convicted of an offense other than a minor traffic violation (Include convictions by military courts-martial)? Yes No
If yes, for each conviction indicate date of conviction, nature of charge and sentence received:
Are you or any relative employed by a company or business that is a client/customer of Atlantic Coast Cleaning? Yes No
If yes, relationship of individual:
Company:
Location:
Position or Title Held:
US Citizen Yes No
If you are not a U.S. Citizen, enter the type of visa and number which verifies your right to be employed in the U.S.
Type of Visa:
Visa Number:
Verified By:
IMPORTANT! PLEASE READ

Our Company policy prohibits discrimination in employment based on race, color, religion, sex, national origin, physical handicap; or age with respect to individuals who are at least 18 years of age.

As a part of this application for employment, which includes a bond application, I hereby authorize Atlantic Coast Cleaning, Inc. and/or the bonding company to investigate my references and to make an independent investigation of my character, conduct and employment records, and to keep and preserve such records.

I agree that failure to reveal any prior employer, or the giving of any false misleading information by me will be grounds for termination of employment. I understand that this employment application and any other company documents do not constitute a contract of employment and that if hired; I or the Company may terminate my employment at any time for any reason. No representative of the Company other that the President and CEO has the authority to enter into any agreement contrary to the foregoing. By clicking "Send Application" and submitting this application, I indicate that I agree to the above statement.

Before submitting your application, please read ACC's privacy notice.

I have read ACC's privacy notice.



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