Vindy Cleaning Job Application

Vindy Cleaning is an equal opportunity employer. The company’s policy is not to discriminate against any applicant or employee based on race, sex, religion, national origin, age disability, or any other basis protected by applicable federal, state, or local laws. Vindy Cleaning also prohibits harassment of applicants or employees base on any of these protected categories. It is also Vindy Cleaning’s policy to comply with all applicable state and federal laws respecting consideration of unemployment status in making hiring decisions.

Position Desired

Date of Application

First Name

Middle Initial

Last Name

Phone

Address line 1

Address line 2

City

State

Zipcode

How Did You Hear About Us?

Current Employee Search Engine Social Media Other

If Other Please State...

If you are under 18 and it is required, can you furnish a work permit?

If no, please explain:

Have you ever been employed here before?

If yes, please give dates and positions:

Do you currently or in the future will you require sponsorship for employment visa status (e.g., H-1B visa status)

Date Available For Work:

What is your desired salary range?

Are you able to perform the essential functions of the job for which you are applying (with or without reasonable accommodation)? This question is not designed to elicit information about an applicant’s disability. Please do not provide information about the existence of a disability, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.

Yes No Need more information about the job's "essential functions" to respond

Driver’s License Information:

State:

Number:

Expiration Date:

Restrictions or Suspensions (respond fully if driving is required by the job for which you are applying):

Skills and Qualifications

Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:

Computer Skills (List computer skills you possess. Include software titles and years of experience):

Criminal History

BEFORE answering the following question, please read the state specific instructions below if you reside in, or are applying for a position in, California, Connecticut, Georgia, Hawaii, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New York, Newark, N.J., Ohio, Pennsylvania or Washington.

**HAWAII, MASSACHUSETTS, MINNESOTA, BUFFALO, NEWARK, PHILADELPHIA, AND SEATTLE APPLICANTS: DO NOT ANSWER THE QUESTION BELOW AT THIS TIME.

Please note that you do NOT have to identify a record of any adult or juvenile arrest, detention or conviction that has been sealed, expunged, annulled, erased, pardoned or statutorily eradicated, set aside or otherwise dismissed by court order.

Please note that answering “YES” to this question will not automatically bar you from employment. Only those crimes which are substantially related to the position you are seeking will be considered.

Have you ever been convicted of a crime?

Yes No

If you answered “Yes”, please provide the following additional information:

Nature of offense:

Misdemeanor Felony

Year of Conviction

County

State

If, subject to the State-Specific Instructions below, you have more than one conviction, please use additional paper to provide the information requested above.

STATE-SPECIFIC INSTRUCTIONS FOR ANSWERING CRIMINAL HISTORY INQUIRY

California Applicants: Do not identify any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been dismissed by a court. Also, do not identify marijuana-related convictions entered by the court more than 2 years ago that involve: unlawful possession of marijuana; transportation or giving away of up to 28.5 grams of marijuana, other than concentrated cannabis, or the offering to transport or give away up to 28.5 grams of marijuana, other than concentrated cannabis; possession of paraphernalia used to smoke marijuana; being in a place with knowledge that marijuana was being used; or being under the influence of marijuana. Also, do not identify any arrest or detention that did not result in a conviction or any record of the referral to, and participation in, any pretrial or post trial diversion program.

Connecticut Applicants: Do not identify any arrest, criminal charge or conviction the records of which have been erased by a court based on sections 46b-146, 54-76o or 54-142a of the Connecticut General Statutes. Criminal records subject to erasure under these sections are records concerning a finding of delinquency or the fact that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or not prosecuted, a criminal charge for which the person was found not guilty, or a conviction for which the offender received an absolute pardon. Any person whose criminal records have been judicially erased under one or more of these sections is deemed to have never been arrested within the meaning of the law as it applies to the particular proceedings that have been erased, and may so swear under oath.

Georgia Applicants: Do not identify any verdict or plea of guilty or nolo contendere that was discharged by the court under Georgia’s First Offender Act.

Hawaii Applicants: DO NOT ANSWER THESE QUESTIONS AT THIS TIME. You will only have to answer this question if you receive a conditional offer of employment. At that time you will be asked whether you have been convicted of a crime within the past 10 years, excluding any period of time when you were incarcerated.

Massachusetts Applicants: Under Massachusetts law, an employer is prohibited from requesting criminal history information on an initial written application. DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD

INFORMATION. You will only have to answer this question if you receive a conditional offer of employment. At that time you will not have to identify any record relating to prior arrests, criminal court appearances or convictions for which the record has been sealed and is on file with the Commissioner of Probation. You also will not have to identify prior arrests, court appearances and adjudications in cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. You also will not have to identify (1) an arrest, detention or disposition regarding any violation of law in which no conviction resulted; (2) first-time misdemeanor convictions for drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace; and (3) convictions for other misdemeanors where the date of conviction or the end of any period of incarceration was more than 5 years ago, unless there have been subsequent convictions within those 5 years.

Michigan Applicants:

Do not identify any misdemeanor arrests, detentions or dispositions that did not result in conviction.

Minnesota Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a job interview or a conditional offer of employment.

Nebraska Applicants: Do not identify a sealed juvenile record of arrest, custody, complaint, disposition, diversion, adjudication or sentence

Nevada Applicants: You must disclose all felony convictions, but may limit disclosure of misdemeanor convictions to those that occurred within the last seven years and resulted in imprisonment. Please note that the discharge and dismissal of certain first time drug offenses, after the accused has completed probation and any required treatment or educational programs, does not constitute a “conviction” for purposes of employment.

Newark, New Jersey Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a conditional offer of employment. At that time you will be asked whether you have ever been convicted of murder, voluntary manslaughter and/or certain sexual offenses. You will also be asked to report any conviction for a disorderly person offense or municipal ordinance violation (within five (5) years of sentencing) or any conviction for any other indictable offense (within eight (8) years of sentencing). If your criminal history includes a reportable conviction for a disorderly person or other indictable offense, you may be asked to report additional non-expunged convictions as allowed by law.

New York Applicants: You may answer “no record” concerning any criminal proceeding that terminated in your favor, per section 160.50 of the New York Criminal Procedure Law; any criminal proceeding that terminated in a “youthful offender adjudication,” as defined in section 720.35 of the New York Criminal Procedure Law; any conviction for a “violation” that already has been sealed by the court, per section 160.55 of the New York Criminal Procedure Law; and any conviction that was sealed pursuant to section 160.58 of the New York Criminal Procedure Law in connection with the licensing, employment or providing of credit or insurance.

Buffalo, NY Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer criminal history questions if you receive a job interview or a conditional offer of employment.

Ohio Applicants: Do not report any arrest or conviction for a minor misdemeanor drug violation as defined under Ohio Rev. Code 2925.11.

Pennsylvania Applicants: Do not identify convictions for summary offenses. Philadelphia, PA Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer this question if you receive a conditional offer of employment.

Washington Applicants: Do not identify any conviction entered by the court more than 10 years ago unless some period of incarceration resulting from that conviction took place within the last ten years.

Seattle, WA Applicants: DO NOT RESPOND TO THE QUESTION SEEKING CRIMINAL RECORD INFORMATION AT THIS TIME. You will only have to answer this question after an initial screen.

Employment History

Applicant may include verifiable work performed on a volunteer basis.

Starting with your most recent employer, provide the following information.

Employer 1

Telephone

Dates Employed (From):

Dates Employed (To):

Address

Compensation (Starting)

Starting Job Title/Final Job Title

Compensation (Final)

Immediate supervisor & title (for most recent position held):

May we contact for reference?

Yes No Later

Why did you leave?

Summarize the type of work performed and job responsibilities:

Employer 2

Telephone

Dates Employed (From):

Dates Employed (To):

Address

Compensation (Starting)

Starting Job Title/Final Job Title

Compensation (Final)

Immediate supervisor & title (for most recent position held):

May we contact for reference?

Yes No Later

Why did you leave?

Summarize the type of work performed and job responsibilities:

Employer 3

Telephone

Dates Employed (From):

Dates Employed (To):

Address

Compensation (Starting)

Starting Job Title/Final Job Title

Compensation (Final)

Immediate supervisor & title (for most recent position held):

May we contact for reference?

Yes No Later

Why did you leave?

Summarize the type of work performed and job responsibilities:

Educational Background

Starting with your most recent school attended, provide the following information:

School

Years Completed

Completed

GPA/Class Rank

Major/Minor

School

Years Completed

Completed

GPA/Class Rank

Major/Minor

School

Years Completed

Completed

GPA/Class Rank

Major/Minor

Reference 1

Reference 2

Reference 3

Lie Detector Disclaimer (Massachusetts and Maryland ONLY)

Massachusetts Applicants: I understand that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Maryland Applicants: I UNDERSTAND THAT UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT OR CONTINUED EMPLOYMENT, THAT ANY INDIVIDUAL SUBMIT TO OR TAKE A POLYGRAPH OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

Application Statement

I certify that all information I have provided in order to apply for and secure work with this employer is true, complete and correct.I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resumé or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using truthful and non–defamatory information, in a lawful manner, in the employment process and all other persons, corporations or organizations for furnishing such information about me.I understand that this employer does not lawfully discriminate in employment and no question on this application is used for purpose of limiting or elimination any applicant from consideration for employment on any basis prohibited by applicable local, state or federal law.I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary for me to reapply and fill out a new application.If I am hired, I understand that I am free to resign at any time, with our without cause and with or without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president.I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.This Company does not tolerate unlawful discrimination in its employment practices. No question on this application is used for the purpose of limiting or excluding an applicant from consideration for employment on the basis of his or her sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status under applicable federal, state, or local law. This Company likewise does not tolerate harassment based on sex, race, color, religion, national origin, citizenship, age, disability, or any other protected status. The Company takes all complaints of harassment seriously and all complaints will be investigated promptly and thoroughly.I understand that any misrepresentation or omission of facts called for may result in refusal to hire or, if hired, may result in my dismissal at any time regardless of when the false answer or omissions are discovered. FODO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.

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