"Coastal Property Maintenance has been responsible for daily cleaning of our office since April, 2006. During this time we have found them very responsible, easy to work with, and reasonably priced. We would recommend them with no hesitation." 

RaeLene K.,
Practice Manager
Emerald Coast Allergy & Asthma Center















Application must be completed in its entirety to be considered for employment.

*Designated required field.


*Date:


*Name:


*Street Address:


*City: *State: *Zip Code:


*Phone: *Cell Phone:


*Email:


*Social Security Number:


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EQUAL EMPLOYMENT OPPORTUNITY

This is a drug-free workplace offering equal employment opportunities. We do not discriminate on the basis of race, creed, color, sex, religion, age, natural origin, disability, citizenship status, veteran status, or any other class protected by state, county, local or federal regulations.

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EDUCATION BACKGROUND

Did you graduate? Years Attended Degree Received & Major Subject
Grammar or High School Yes/No

Location:


Trade, Business or Vocational Yes/No

Location:


College Yes/No

Location:


Graduate School Yes/No

Location:


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SPECIAL SKILLS AND QUALIFICATIONS

Do you have any special skills, training, or experience that might help you qualify for a position at this company:
Yes   No


List any professional, trade business, or home activities that would relate to the work here:


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WORK HISTORY

List your most recent job first. you must include any gaps in employment, with a full explanation and dates for the game. You must also provide a complete work history for a minimum of 10 years, if applicable. You may attach additional sheets if you need more space. A resume is not a substitute for this section. To be considered for employment, this section must be completed.

*Employer's Name:


*Dates Employed From: *End Date:

To



*Address:


*Phone:


*Supervisor's Name:


*Job Title:


*Hourly Rate/Annual Salary Starting:
*Final Salary:



*Status:
Still Employed Resigned

Terminated
*State Reason:



********************************************************************

EMPLOYER #2

*Employer's Name:


*Dates Employed From: *Start Date:

To



*Address:


*Phone:


*Supervisor's Name:


*Job Title:


*Hourly Rate/Annual Salary Starting:
*Final Salary:



*Status:
Still Employed Resigned

Terminated

*State Reason:



********************************************************************

EMPLOYER #3

*Employer's Name:


*Dates Employed From: *Start Date:

To



*Address:


*Phone:


*Supervisor's Name:


*Job Title:


*Hourly Rate/Annual Salary Starting:
*Final Salary:



*Status:
Still Employed Resigned

Terminated

*State Reason:



********************************************************************

 

GENERAL INFORMATION

You must answer every question. If a question does not apply, put "N/A".

1. What position(s) are you applying for?: 
2. What is your salary expectation?:  
3. How were you referred to us?: 

4. Have your completed an application here before?:  Yes  No
5. When can you start work / (Date):  
6. Are you available to work (check any that apply):   
  Full-Time  Part-Time   Temporary  Weekends

7. Are there any days or times during the week that you are not available to work?:   
  Yes  No

If yes, please list the day/times you are not available to work and why.

8. Are you willing to work overtime?:   
  Yes  No
Are you at least 18 years old?:   
  Yes  No

9. Do you have steady transportation to work?:   
  Yes  No

Are you employed now?:   
  Yes  No

10. May we contact your present employer?:   
  Yes  No

11. Why do you desire to make a change?

12. Are you legally eligible to work in the United States?:   
  Yes  No

13. Do you hold a valid Driver's License?:    Yes  No
Driver's License Number:


14. Have you had any moving violation(s) or accidents in the last three years?:    Yes  No
If yes, give date(s) and explanation of each.

15. What three adjectives best describe you?


16. What three things are most important to you in a job?


17. Why do you want to work here?


18. What type of work do you most enjoy?


Answering "yes" to questions 20-25 is not an automatic bar to employment.

19. Have you ever been convicted of or have you ever received a sentenced for a crime(s) other than a minor traffic violation?:    Yes  No
If so, for each, list type of conviction/sentence, date of the offense, court, and place where the offense occurred.
20. How much time have you lost from work during the past 12 months:   


21. Have you ever been terminated or asked to resign from a job?:    Yes  No
If yes, explain.


22. Have you ever been disciplined at any job for an act of violence, harassment, or discrimination?:    Yes  No
If yes, explain the circumstances, employer, and date.


********************************************************************

Coastal Property Maintenance Agreement and Release Information

For the purpose of this agreement and release, the organization that has provided you with this application is referred to as "the company", "this company", or "you". The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment.

You are hereby authorized to make any investigation of my personal history, financial, criminal, credit, and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment.

I agree to submit to any drug or alcohol testing prior to or after employment, and I agree to submit to a medical evaluation, if required. In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends, or others with whom I am acquainted.

In exchange for the consideration of my employment application by this company, I hereby release and forever discharge this company (including its directors, officers, employees, and agents) and my past and/or present employers (their directors, officers, employees, and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record.

I understand that if my application is accepted that employment with this company at all times is employment "by contract". It is further understood that this contractual relationship may not be changed by any verbal statements or by conduct unless an authorized executive of this company specifically acknowledges such change. I further understand that my contractual employment may be terminated at any time by this company or myself and includes no guarantee, contract, or promise of employment for any specific length of time. I understand that the first 90 days of employment is a new-hire introductory period.

By entering your name, you are submitting your digital signature.
Signature* 

Date of Birth:    (mm/dd/yyyy)

As Coastal Property Maintenance is a EEOC compliant company, your date of birth will only used for the purpose of a background check and will not reflect any employment decision made.

 

 

 







Phone: (850) 217-4285
Email:
ronnie@coastalpropertymaintenance.net  

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