Apply For A Career Personal Information: First Name Last Name Your Email Telephone Current Address Employment Desired: Location ---LaCrosse (Quick N Clean)Onalaska (Ship Shape)Either Location Position Date you can start Are you employed now? yesno If so, may we inquire of your present employer? yesno Are you legally authorized to work in the United States? ---yesno Education History High School Did you graduate? yesno College Did you graduate? yesno Trade, Business, Correspondence School, or Other Former Employers (List Below the last two employers, starting with last one first) Employer Start Date End Date Position Hourly Wage Reason for leaving? Employer Start Date End Date Hourly Wage Position Reason for leaving? References (Give below the names of three persons not related to you, whom you have known for at least one year) Full Name: Phone Number: Full Name: Phone Number: "By selecting Submit, I ceritfy 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 and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner progibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws"