Alexandria Domestic Services' Job Application

Alexandria Domestic Services, LLC is an equal opportunity employer and does not discriminate in hiring or employment on the basis of race, religion, color, national origin, sex, age, disability, veteran status or any other prohibited basis. No question on this application is intended to secure information to be used for such discrimination.

Personal Information

First Name

Last Name

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Primary Contact Phone Number

### - ### - ####

Alternate Phone Number

### - ### - ####

Email

Prior Address (if less than three years at current address)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Are you eligible to work in the United States? *

Yes

No

If you are under age 18, do you have an employment/age certificate?

Yes

No

If yes, please explain:

Days Available

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Any

Hours Available

AM

PM

What date are you available to start work?

MM / DD / YYYY

EDUCATION:

Name and Address Of School - Degree/Diploma - Graduation Date

Skills and Qualifications: Licenses, Skills, Training, Awards

EMPLOYMENT HISTORY:

Present Or Last Position:

Employer:

Address:

Supervisor:

Phone Number

### - ### - ####

Email

Confirm email

Your Position

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

Previous Position

Employer:

Address:

Supervisor:

Phone Number

### - ### - ####

Email

Confirm email:

Position Title:

Start Date

MM / DD / YYYY

End Date

MM / DD / YYYY

Responsibilities:

Salary

Input hourly wage, if not salaried.

Reason for Leaving:

May We Contact Your Present Employer?

Yes

No

References:
Name/Title Address Phone

Terms and Conditions

In submitting this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I understand that prior to employment Alexandria Domestic Services will conduct any investigation necessary concerning any part of my background related to the position I am seeking, including, but not limited to, obtaining a police report and driving record. I will be responsible for familiarizing myself with all rules and regulations of the company as they presently exist or are later modified and that I will abide by its rules and regulations which I understand are subject to change. I also understand that no representative of the company has any authority to enter into any employment agreement for any specified period of time or to assure me of any future position, benefits, or terms and conditions of employment. I further understand that if hired, my employment is for no definitive period of time and it may be terminated by either party at any time.

Do you agree with the terms and conditions? *

Yes, I agree.

Initial *

Date *

MM / DD / YYYY

Contact Information

Email

Best Time / Day to Call

Eligibility

Do you have a current valid driver's license?

Yes

No

Note: Driving is a requirement of this job. Alexandria Domestic Services will obtain a copy of your valid driver's license at the time of your personal interview to confirm its validity .

Do you have your own vehicle?

Yes

No

If you have your own vehicle, is it insured?

Yes

No

Not applicable.

Can you provide verification of your legal right to work in the United States?

Yes

No

Please note: We will obtain your Social Security Number at the time of your personal interview and ask for verification of your legal work status and completion of the I-9 form no later than three business days after hire.

Would you have difficulty standing, bending or kneeling in connection with performing the necessary cleaning duties?

Yes

No

Have you ever been convicted of a criminal Offense?

Yes

No

Due to the security-sensitive nature of the job, all employees are required to be bonded. As a matter of policy, the company conducts a police background and driving record check on any application in consideration of hiring.

Additional Comments

If there is anything you would like to add, please make your comments in the box below:

Thank you very much for taking the time to apply for work with Alexandria Domestic Services, LLC.

How did you hear about us?

Alexandria Domestic Services Job Application

Personal Information

EDUCATION:

EMPLOYMENT HISTORY:

Terms and Conditions

Contact Information

Eligibility