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The Region's Premier
Uniform & Linen
Service & Sales Company


1.800.292.1224

Employment Application

Applicant Note

This application form is intended for use in evaluating your qualifications for employment. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, or physical handicap, or the presence of disabilities. A conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.

Application Form

Applicant Information







Current Address





Previous Address





Availability




 Weekdays Weekends Evenings Nights Overtime Shift Other

Job Related Skills (Note: do not fill out any part of this section you believe to be non-job related.)


 Yes No





 Yes No




 Yes No

 Yes No

 Yes No

General Questions





 3 Months 6 Months 1 Year 2 Years 3 Years 5 Years+


 Yes No


 Yes No








 Yes No

 Excellent Good Fair Poor

 Yes No


 $7.00 $8.00 $9.00 $10.00 $12.00 $14.00 $16.00+

 $0 to $5,000 $5,000 to $10,000 $10,000 to $15,000 $15,000 to $20,000 $20,000 to $25,000 $25,000 to $30,000 $30,000+ Other

Previous Employment

Please Note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY.

Most Recent Employeer



 Yes No









 


 


Next Most Recent Employeer



 Yes No









 


 


Next Most Recent Employeer



 Yes No









 


 


References










Education


 7 8 9 10 11 12


 1 2 3 4

 1 2 3 4

High School





College





Other





Emergency Contact





Security



 Yes No

Certification & Release

 I certify that I have read and understand the applicant note on page one of this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and/or its agents to verify any of this information, including consumer credit reporting bureau and Workers Compensation reports. I release and indemnify all former employers, persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

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