Mess Busters, Inc

Mess Busters, Inc.

PO Box 398926

Miami Beach, FL 33239-8926

Phone 305-673-MESS (6377)

Fax 305-672-8326

To applicant: We deeply appreciate you interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future upgrading. Applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital o veteran status, or the presence of a non-job-related medical condition or handicap. Questions directly or indirectly reflecting such status have been included only where needed to determine a bona fide occupational qualification or for other permissible purposes. All positions are offered on an independent contractor basis.

FOR PERSONNEL DEPARTMENT USE ONLY

EMPLOYED: YES NO STARTING DATE _________________________________

HOURLY RATE __________________ SALARY ___________________

FULL TIME P PART TIME ____________________________________________________________________

(Days/Hours)

Application For Employment

DATE OF APPLICATION __________________________________________

REFERRAL SOURCE» AD___» AGENCY___» CURRENT EMPLOYEE___

» NEWS JOURNAL___» FLYER___» FRIEND/RELATIVE _______________

» OTHER___

REFERRED BY: ____________________________

NAME: ___________________________________________________________________________________________________

LAST FIRST MIDDLE

PRESENT ADDRESS _______________________________________________________________________________________

STREET CITY STATE/ZIP

E-mail: ___________________________________

TELEPHONE ( ) _________________________ WORK PHONE: ________________________________________

SOCIAL SECURITY #: ______________________________________

» OWN HOME___» RENT ___» BOARD___

In case of emergency, whom should we notify?

NAME ____________________________ RELATIONSHIP __________________ HOME PHONE ( )__________________

ADDRESS _________________________________________________ WORK PHONE ( )_________________

Position: _________________________

On what date will you be available for work? _________________

Available days: ___________________________ Available nights: ____________________________

Time available: ___________________________

Can you travel to other areas? » YES___ » NO___

Do you have any friends or relatives employed by us? » YES___ » NO___

If yes, please state name _____________________

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?

» YES___ » NO___

(Proof of citizenship or immigration status may be required upon employment).

Have you been convicted of a felony in the past 7 years, other than a traffic violation? (This will not necessarily exclude you from employment). » YES___ » NO___ If yes, please explain: _______________________________________________________________________________________

RECORD OF EDUCATION

EDUCATION	Name and Location of School	Years Attended	Date Graduated	Subjects of special study or research work
High School

College

Trade or Vocational School

Former Employers * (List Below last 4 Employers, starting with the most recent)

Date Month and Year	Name and Address of Employer	Salary	Position	Reason for Leaving
From
To	Supervisor:
From
To	Supervisor:
From
To	Supervisor:
From
To	Supervisor:

Currently employed? » YES___» NO___

May we contact your present employer? » YES___» NO___

May we contact your previous employers? » YES___» NO___

Have you applied here before? » YES___» NO___ When? ______________________________________

Physical Record.

Do you have any physical defects that preclude you from doing any work for which you are being considered? » YES___ » NO___

Give details: _______________________________________________________________________________________________

Have you ever been injured? » YES___ » NO___ Give details: __________________________________________________

Any defects in: » Hearing?___» Vision?___» Speech?___

REFERENCES: Give below the names of 3 persons not related to you, whom you have known at least one year.

Name	Address	Business	Years Acquainted

AGREEMENT

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

In the event of employment, I understand that omission of facts, false or misleading information given in my application or interview's) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company.

Signature of Applicant _________________________________________ Date _________________________________________

PO Box 398926 Miami Beach, FL 33239-8926

305-673-MESS (6377)

I ____________________________ (last, first and middle name)

do hereby give Mess Busters, Inc. the authority to do any type of background check in regard to my services with Mess Busters, Inc. Further, I understand and agree that 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 previous notice. Such manufacturer of this form assumes no responsibility and hereby disclaims any liability for inclusion, in this form, of any questions upon which a violation of State and federal fair employment practice laws may be based. ______________________________________________________

Signature: _______________________________________________________

Social Security Number: ____________________________________________

Date of Birth: ____________________________________________________

Address: _______________________________________________________

City, State & Zip Code: ____________________________________________

Telephone (Home, Cell & Fax): ______________________________________

Driver's License Number: ___________________________________________