Employment

Helping Hands Services

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Applications for work need to be completely filled out and submitted,
Resumes can be mailed to:
Helping Hands Services
1001 Grant Ave.
Baxter Springs, KS 66713

Application For Employment

First Name: *
Last Name: *
Maiden Name:
Social Security #: *
Current Address: *
Phone: *
Cell Phone:
E-mail Address: *
City: *
State: *
Is this your permanent address?: *
Date of Birth (Mo/Day/Year): *
Are you a Citizen of the USA?:

Have you ever been employed by a cleaning service?:
How Long:
Name and Location of Company?:

Do you have any Friends or Relatives employed by Helping Hands?:
If Yes, Name and Relation:

Referred by:
Relationship:

Incase of Emergency, Notify: *
Relationship:
Street Address:
City:
State:
Zip:
Phone: *

Yes	Have you ever been convicted of a crime? (Other than a Traffic Violation)

If Yes, Explain:

Yes	Do you have any physical impairments, that would interfere with your performance of this Job?

If Yes, Explain:

_______________________________________________________________

LIST THE NAMES OF TWO REFERENCES
(NOT RELATED TO YOU)

Reference Name: *
Phone Number: *
Address:
Occupation:

Reference Name: *
Phone Number: *
Address:
Occupation:

PREVIOUS EMPLOYMENT
(COVER AT LEAST THREE YEARS)

#2 Name of Employer: *
Address of Employer:
City: *
State: *
Zip: *
Phone Number: *
Supervisor's Name: *
Date Started (Mo/Day/Year):: *
Length of Time at this Employer in Years:
Position:
Salary Per Hour:
Reason for Leaving:

#3 Name of Employer:
Address of Employer:
City:
State:
Zip:
Phone Number:
Supervisor's Name:
Date Started (Mo/Day/Year):
Length of Time at this Employer in Years:
Position:
Salary Per Hour:
Reason for Leaving:

I AUTHORIZE INVESTIGATION OF ALL STATEMENT CONTAINED IN THIS
APPLICATION. I UNDERSTAND MISREPRESENTATION OR OMISSION
OF FACTS CALLED FOR IS CAUSE FOR DISMISSAL WITHOUT NOTICE
AT ANYTIME DURING MY EMPLOYMENT.

I UNDERSTAND THAT MY APPLICATION WILL REMAIN ACTIVE FOR A PERIOD
OF ONE YEAR FROM Date OF APPLICATION.

HELPING HANDS SERVICES IS AN EQUAL OPPORTUNITY EMPLOYER

Signature of Application: *
Date: *
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