Scrub-A-Dub is always looking for individuals with positive attitudes, strong work ethics, and the ability to get along with others. Fill out our online application and become part of the Scrub-A-Dub team. |
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Scrub-A-Dub Online Employment Application |
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| Personal Information: |
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Middle |
Last |
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| Address |
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Apt |
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State |
Zipcode |
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| Phone (333-555-5555) |
Phone for Messages |
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| Are you a US Citizen |
What proof of identification do you have? |
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| Employment Desired: |
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| Position |
When can you start? |
Salary Desired |
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| Were you ever employed by us? |
If yes when? |
Where? |
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| Are you employed now? |
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| What Experience, Skills, or Qualifications do you do you possess that would make you a strong candidate for employment with us. |
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| List any friends or relatives working for us |
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| Military Record: |
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| Were you in the armed forces? |
If yes what branch? |
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| Dates of Duty: |
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To |
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| Lists of duties including special training: |
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To Applicant: READ THIS INTRODUCTION CAREFULLY BEFORE ANSWERING ANY QUESTIONS IN THIS BLOCKED OFF AREA. The Civil Rights Act of 1964 and Wisconsin Fair Employment Act, Sect. 111.322 prohibits discrimination in employment because of race, color, religon, sex or national origin. Federal laws also prohibit on the basis of age with respect to certain individuals. The laws of most States also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based on ancestry, marital status or physical handicap or disability.
The Questions contained in this blocked off area are needed for a permissible reason including without limitation, a bona fide occupational qualification or business necessity. Please answer each question. |
| Have you ever been convicted of a felony or a crime? |
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| If yes, please explain and give dates: |
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| Record of Education: |
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| Elementary School Name |
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Subjects Studied: |
| Location |
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| Check last year completed: |
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| Did you graduate? |
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| Highschool Name |
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Subjects Studied: |
| Location |
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| Check last year completed: |
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| Did you graduate? |
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| College Name |
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Subjects Studied |
| Location |
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| Check last year completed: |
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| Did you graduate? |
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| Trade, business, or other |
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Subjects Studied: |
| Location |
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| Check last year completed: |
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| Did you graduate? |
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| List below all present and past employment (last 4), begining with most recent: |
| Name of Company |
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| Address |
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| Type of Business |
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| From |
To |
Total (Years / Months) |
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| Hourly Starting Salary |
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Describe the work you did: |
| Hourly Ending Salary |
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| Reason for Leaving |
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| Name of Supervisor |
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| May we contact this employer? |
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| Name of Company |
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| Address |
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| Type of Business |
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| From |
To |
Total (Years / Months) |
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| Hourly Starting Salary |
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Describe the work you did: |
| Hourly Ending Salary |
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| Reason for Leaving |
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| Name of Supervisor |
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| May we contact this employer? |
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| Name of Company |
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| Address |
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| Type of Business |
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| From |
To |
Total (Years / Months) |
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| Hourly Starting Salary |
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Describe the work you did: |
| Hourly Ending Salary |
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| Reason for Leaving |
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| Name of Supervisor |
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| May we contact this employer? |
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| Name of Company |
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| Address |
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| Type of Business |
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| From |
To |
Total (Years / Months) |
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| Hourly Starting Salary |
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Describe the work you did: |
| Hourly Ending Salary |
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| Reason for Leaving |
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| Name of Supervisor |
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| May we contact this employer? |
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"I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALSIFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL.
i AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIUOS EMPLOYMENT AND ANY PERTINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM FURNISHING SAME TO YOU.
I UNDERSTAND AND AGREE THAT, IF HIRED MY EMPLOYMENT IS FOR NO DEFINITE PERIOD AND MAY, REGARDLESS OF THE DATE OF PAYMENT OF MY WAGES AND SALARY, BE TERMINATED AT ANY TIME WITHOUT ANY PRIOR NOTICE." |
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Initials: |
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