Employment Application — NEMCO, Inc.

43 Elizabeth Street Hackensack, NJ 07601 (201) 883-1008 office@nemcoinc.com

Personal Information

Full name *

Date of birth *

Street address *

City *

State *

ZIP *

Email *

Home phone

Cell phone *

Social Security Number is not collected here. If you are offered a position, NEMCO will collect it securely during onboarding.

Availability

Position type * Full-time Part-time

Do you have a driver’s license? * Yes No

Hours available — from

Hours available — to

Transportation I have a car to work I must take the bus to work

Experience & Language

Previous cleaning experience (check all that apply)

Office cleaning
Strip / wax floors
Buffing floor machine
Shampoo extractor machine
Windows
House cleaning

Languages spoken

English
Spanish

Other language(s)

Previous Employment

Most recent employer

Company name & address

Supervisor / contact

Phone

From (mo / yr)

To (mo / yr)

Reason for leaving

Previous employer

Company name & address

Supervisor / contact

Phone

From (mo / yr)

To (mo / yr)

Reason for leaving

Personal References

Reference 1 — Name

Address

Phone

Reference 2 — Name

Address

Phone

Name of person referring you to Nemco

Health & Emergency Contact

Do you have any physical condition which may limit your ability to perform the job applied for? No Yes

If yes, please explain

Emergency contact — name *

Emergency contact — phone *

Emergency contact — address

Acknowledgments

Nemco, Inc. is a drug-free company. Employees are subject to random drug testing.
Nemco, Inc. es una compañía libre de drogas. Los empleados son sometidos a exámenes de droga al azar.

I acknowledge the drug-free workplace policy. *

Nemco, Inc. performs background checks on all applicants.
Nemco, Inc. realiza verificaciones de antecedentes de todos los solicitantes.

I consent to a background check. *

Applicant signature (type your full legal name) *

Date *

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