Careers — Amazon Air Duct Cleaning

EMPLOYMENT APPLICATION

Once you submit the application, please submit the required documentation to careers@amazonadc.com. Include your full name in the subject line. Should you have any questions please email us at careers@amazonadc.com

Applicant Full Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Number of years at this address

Phone

(###)

###

####

Mobile Phone

(###)

###

####

Social Security Number

Driver's License Number and State

Emergency Contact Name

First Name

Last Name

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Phone

(###)

###

####

Salary Desired

Are you at least 18 years old?

YES

Are You willing to work Tuesday-Saturday?

YES

If applicable, are you available to work overtime?

YES

If you are offered employment, when would you be available to begin work?

YYYY

Have you ever been convicted of a felony or misdemeanor?

Yes

EMPLOYMENT HISTORY

Employer Name (Company Name):

Supervisor Name

First Name

Last Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Job Duties

Reason for leaving

Employed from:

YYYY

Employed till:

YYYY

Date

YYYY

Employer Name (Company Name):

Supervisor Name

First Name

Last Name

Employer Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Job Duties

Reason for leaving

Employed from:

YYYY

Employed till:

YYYY

References

Reference 1, Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Relationship

Reference 2, Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Relationship

Please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

CERTIFICATION: I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination. I authorize Brekmar Inc to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education. I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Applicant Signature

Date

YYYY