vibraclean.com

Date of Application ... *

Date Available to Start ... *

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Pay Expectations

Cleaner Yes No *

Supervisor Yes No *

Worklift operator Yes No *

Full-time Yes No *

Part-Time Yes No *

Day Time Yes No *

Night Time Yes No *

First Name *

Middle name

Last Name *

Apartment number

Street Address *

City *

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Postal Code *

Home Phone *

Cell Phone

Email Address *

Are you legally eligible to work in Canada Yes No *

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Current / Most Recent Employer Name *

Can we contact this company? Yes No *

Start Date ...

End Date ...

Supervisor Phone Number *

Your Position *

Duties (200 chars left) Please describe briefly your duties *

Reason for Leaving *

Starting Pay

Ending pay

Other Employers (200 chars left) Describe briefly other employers history *

Have you ever worked at Vibraclean before Yes No *

If Yes, when?

Why did you leave?

The undersigned acknowledges that the foregoing statements and information fully and truthfully set forth the true and accurate personal information of the applicant as of the date hereof. The undersigned further acknowledges that for the purposes of determining the suitability of the undersigned for the position applied for, an investigation may be made with respect to relevant information. The undersigned hereby consents to Vibraclean Corporate Housekeeping collecting and retaining such information and conducting further investigations with respect to relevant information. The undersigned further consents to the updating of this information from time to time, as necessary. Please exclude any reference to any organization which could indicate race, religion, marital status, age, colour, gender, ancestry, political beliefs, sexual orientation, place of origin, physical disability, mental disability, or handicap.

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