Sunshine Commercial Cleaning Services

Application For Employment

PLEASE PRINT CLEARLY AND PROVIDE ALL REQUESTED INFORMATION If you need assistance in completing this application, please let us know so that we can discuss a reasonable accomodation. GENERAL INFORMATION NAME( Last, First, Middle) Age ( If you are under 18, you may have to provide a work permit before starting work) Are you at least 18 years old? YES NO Are you at least 16 years old? YES NO ADDRESS (No., Street, City, State, Zip) PHONE ( Primary) PHONE ( Secondary) POSITION POSITION DESIRED FULL TIME (35+ Hrs/ Week) PART TIME ( Less Than 35 Hrs/ Week) SEASONAL ONLY YES NO TODAY'S DATE ___/ ___/ ___

WAGE DESIRED WHEN AVAILABLE HOW LONG AVAILABLE

WILL YOU WORK OVERTIME HOURS IF NECESSARY? AVAILABILITY WEDNESDAY THURSDAY FRIDAY

DAY SUNDAY TIME FROM TIME TO

MONDAY TUESDAY

SATURDAY

NOTE: Although every effort to accommodate individual preferences will be made, business needs may require any or all of the following: extention of hours, a rotating work sehedule , Saturday and/ or Sunday hours, overtime. EMPLOYMENT RECORD Please complete in full even if you have provided a resume. You may include military service and verifiable work performed on a voluntary basis. CURRENT/ LAST EMPLOYER NAME AND ADDRESS PHONE NUMBER TYPE OF BUSINESS MAY WE CONTACT THE COMPANY? JOB TITLE DUTIES AND RESPONSIBILITIES DATES EMPLOYED FROM: SUPERVISOR NAME/ TITLE REASON FOR LEAVING CURRENT/LAST EMPLOYER NAME AND ADDRESS PHONE NUMBER TYPE OF BUSINESS MAY WE CONTACT THE COMPANY? JOB TITLE DUTIES AND RESPONSIBILITIES DATE EMPLOYED FROM: SUPERVISOR NAME/ TITLE REASON FOR LEAVING CURRENT/ LAST EMPLOYER NAME AND ADDRESS PHONE NUMVBER TYPE OF BUSINESS MAY WE CONTACT THE COMPANY? JOB TITLE DUTIES AND RESPONSIBILITIES DATE EMPLOYED FROM: SUPERVISOR NAME/TITLE REASON FOR LEAVING

YES TO: WAGE RATE/ SALARY

NO

YES TO: WAGE RATE/ SALARY

NO

YES TO: WAGE RATE/ SALARY

NO

PROFESSIONAL REFERENCES List(2) persons familiar with your work ability ( exclude relatives) NAME PHONE NUMBER HOW DO YOU KNOW THIS PERSON NAME PHONE NUMBER HOW DO YOU KNOW THIS PERSON

HOW LONG HOW LONG

[OVER]

EDUCATION INSTITUTION NAME, STREET, NUMBER CITY, OF ZIP YEARS COMPLETED HIGH SCHOOL COLLEGE ADDITIONAL TRAINING OTHER INFORMATION INTERNET AGENCY COURSE/MAJOR DIPLOMA/ CERTIFICATE OBTAINED

HOW DID YOU LEARN OF WALK-IN THIS POSITION? SIGN

NEWPAPER

ASSOCIATE REFERRAL CTS REFERRING ASSOCIATE'S NAME YES NO

HAVE YOU EVER WORKED OR APPLIED FOR THIS OR ANY BED BATH & BEYOND COMPANY (BB&B, CTS, HARMON OR BUYBUY BABY) BEFORE? IF YES, PLEASE INDICATE LOCATION AND DATES OF APPLICATION AND/ OR EMPLOYMENT: HAVE YOU EVER BEEN DISMISSED OR ASKED TO RESIGN FROM ANY EMPLOYER? IF YES, PLEASE EXPLAIN: DO YOU HAVE ANY RELATIVES EMPLOYED BY CHRISTMAS TREE SHOPS? IF YES, PLEASE SPECIFY: DO YOU HAVE ANY SPECIAL SKILLLS, OR OPERATE EQUIPMENT OR MACHINERY? IF YES, PLEASE SPECIFY:

YES

NO

YES

NO

YES

NO

TO BE COMPLETED BY APPLICANTS IN NON- MASSACHUSETTS LOCATIONS ONLY: HAVE YOU EVER BEEN CONVICTED OF A FELONY? IF YES, PLEASE EXPLAIN: NOTE: A conviction will not necessarily result in a denial of employment. Employment decisions will be dependent upon a review of the nature/ date of conviction and position applied for. DISTRIBUTION CENTERS ONLY I understand and agree that as a condition of employment I may be required to undergo and sucessfully pass a screening of alcohol and/ or drugs during the hiring process and if employed, as required by the employer. I also understand that any offer of employment in a Truck Driver position will be contingent upon my sucessful completion of a pre-employment physical examination that the employer may require.

SIGNATURE C E R T I F I C A T I ON It is unlawful to require or administer a lie dtector test as a condition of employment or continued emploment. An employer who violates this law shall be subject to criminal penalties and civil liability. I understand that the employer follows an "employment at will" policy, in that the employer or I may terminate my employment at any time, or for any reason consistent with applicable State or Federal Law with or without notice. I understand this application will be considered for (3) months; after that time, if I wish to be considered for employment, I must submit a new application. The information that I have provided on this application is a true and complete statement of facts. If employed, any omissions, false or misleading statements made herein or during the interview process could result in termination of employment regardless of when such information is discovered. I authorize all courts, probation departments, prosecutor's offices, boards, employers, educational and credit companies, other instutions and agencies, without exception, to furnish the Company or its representatives any information concerning me. This waiver does not permit the release or use of disability related or medical information in a manner prohibited by the Americans With Disabilities Act (ADA) and other relevant Federal and State laws. I further authorize a check by any consumer agency of my employment history as well as any incidents of employment dishonesty, retail theft or criminal activity. I understand that my employment and/ or retention may be affected in a whole or in part from a report received from this agency. I hereby discharge and exonerate the Company, it's agents and representatives or any person so furnishing information from any liability and all liability of every nature and kind arising out of the furnishing, inspection or collection of such documents, records, and other information or the investigation made by the Company. A photocopy of this authorization will be considered as effective and valid as the original. Where ever legally required, a copy of any credit report or other information will be made available upon request. I agree to protect the Company's confidential information, trade secrets, and other proprietary information and will not reveal such information to anyone at any time during or after cessation of my employment. I understand that the Company will not employ persons who use illegal drugs or engage in substance abuse, and that the Company reatains the right to screen such individuals from employment. My signature certifies that I have read and agree with the above statements. SIGNATURE DATE