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APPLICATION FOR EMPLOYMENT


INSTRUCTIONS TO APPLICANTS
TO BE CONSIDERED FOR EMPLOYMENT, YOU MUST ANSWER ALL QUESTIONS AND COMPLETE ALL SECTIONS OF THIS APPLICATION FORM.

WHEN COMPLETING THIS APPLICATION, PLEASE MAKE SURE YOU
• COMPLETE THE SECTION FOR EQUAL OPPORTUNITY INFORMATION.

• APPLY FOR ONE VACANCY PER APPLICATION.

• GIVE COMPLETE INFORMATION ON YOUR EDUCATION AND WORK HISTORY (“SEE RESUME” IS NOT ACCEPTABLE).

• LIST SEPARATELY EACH JOB HELD AND YOUR DUTIES FOR EACH POSITION WHEN YOU WORKED FOR ONE EMPLOYER AND HELD MORE THAN ONE POSITION.

• PROVIDE YOUR SOCIAL SECURITY NUMBER.

• CHECK FOR ACCURACY, SIGN AND DATE YOUR APPLICATION.

THANK YOU FOR YOUR INTEREST IN OUR COMPANY. ALTHOUGH EVERYONE WHO APPLIES CANNOT BE HIRED, YOUR APPLICATION WILL BE GIVEN EVERY CONSIDERATION.


Equal Opportunity Information
State Government policy prohibits discrimination based on race, sex, color, creed, national origin, age or disability. Sex, age or absence of disability is a bona fide occupational qualification in a small number of State jobs. The information requested below will in no way affect you as an applicant. Its sole use will be to see how well our recruitment efforts are reaching all segments of the population.
Date of Birth

(Month) (Day) (Year)

Gender
0 0
Male Female
DISABILITY: “Disability means, with respect to an individual: (1) a physical or mental impairment that substantially limits one or more of the major life activities of such individual; (2) a record of such an impairment; or (3) being regarded as having such an impairment” (Americans with Disabilities Act of 1990). Persons without a disability should check item A.
The reporting of a disability is strictly VOLUNTARY. Persons with disabilities who DO NOT WISH to report their disabilities should check item A. Information reported on this form will be kept confidential as required by State law.
FOR OFFICE USE ONLY:
A 0 None/Prefer not to report
B 0 Blind or severely visually
impaired
C 0 Deaf or severely hearing
impaired
D 0 Loss of limited use of arms
and/or hands
E 0 Non-ambulatory (must use
wheelchair)
F 0 Other orthopedic impairment
(including amputation, arthritis,
back injury, cerebral palsy, spina
bifida, etc.)
G 0 Respiratory impairment
H 0 Nervous system/Neurological
disorder
I 0 Mentally restored
J 0 Mental retardation
K 0 Learning disability
L 0 Others (heart disease, diabetes,
speech impairment)
M 0 Other (please specify)
______________________


APPLICATION FOR EMPLOYMENT
STATE OF
FLORIDA Date of Application


(LAST FOUR OF): Social Security No.

Last Name

First Name

Middle Name


Address (Street number and name)

City

County


State

Zip Code

Phone (Home)

Phone (Cellular)


Other Phone: Email Address: Other source of contact:
Availability
DATE YOU BEGIN WORK:
___/ ___/ ____
Are you related by blood or marriage to any person now working for Miami Uniforms 0 YES 0 NO
If yes, give name, relationship to you and the location where employed.


If subject to Military Selective Service registration, certify compliance by initialing dotted line
..................................
Military Service
Have you served honorably in the Armed Forces of the United States on active duty for reasons other than training? 0 YES 0 NO
Do you wish to declare a service-connected disability? 0 YES 0 NO
At the time of this application, are you the surviving spouse or dependent of a deceased veteran who died from service-related reasons? 0 YES 0 NO
Do you wish to declare eligibility for veterans preference as the spouse of a disabled veteran? 0 YES 0 NO
Give dates of your (or spouse’s) qualifying active military service:
Entered: Separated: Branch: Rank
Are you a member of the Military Reserves? 0 YES 0 NO Branch: Rank:

CHECK the types of work you will accept:0 1. Permanent full-time 0 2. Permanent part-time 0 3. Temporary full-time 0 4. Temporary part-time 0 5. Any of the preceding 0 6. Work involving Travel 0 7. Shift or Split Shift Work
If you are not available for work now, enter the earliest date you could begin work (mo/day/yr.)
Will you accept work at any of our locations? 0 YES 0 NO (If no, list below the counties in which you would be willing to work.)
List any days you are unable to work: ________________________________________________________________________________________________________
Please list any hours you are unable to work: If left blank, This means you are available from 8am-11pm ________________________________________________________________________________________________________

Will you be able to work our midnight shift 11pm-8am _________________________________________________________________________________________
Will you have a vehicle with you during working hours for travel? _____________________ If so, what type of vehicle? _______________________________________
Please list what type of insurance coverage you caring, company name, and the amount insured: ________________________________________________________
______________________________________________________________________________________________________________________________________
Jobs Applied For
Enter below the specific title(s) of the job(s) for which you are applying. Please list no more than three on this application.
1. 2. 3.

Referral Source
Please indicate your referral source:
If you were referred by the Employment Security Commission (Job Service) please indicate which local office:

Education
Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 GED College 1 2 3 4 Graduate School 1 2 3 4
Under S/Q Hrs., list the hours of credit received and if they were semester (S) or quarter (Q) hours.

Schools
Name and Location Dates Attended (mo/yr)
From: To:
Grad?
S/Q Hrs.
Major/Minor Course Work Type of Degree Received

High School


YES 0
NO 0

College(s)
University (s)


YES 0
NO 0




Graduate or
Professional


YES 0
NO 0




Other educational, vocational school, internships, etc.


YES 0
NO 0




Special training programs and seminars you have completed in the last five years (list):


If the job(s) applied for calls for specific courses, indicate those courses taken and credits received:


Current professional status: (List fields of work for which you have been registered)
Registration: State: No.
Registration: State: No.

Membership in professional, honorary, or technical societies (list):

DO NOT COMPLETE THIS BLOCK
DEGREES AND PROFESSIONAL CREDENTIALS
0 Have been verified
0 Will be verified within 90 days (G.S. 126-30)
Person Responsible:
PERSONAL REFERENCES:
PLEASE LIST THE NAMES AND CONTACT INFORMATION OF 3 PERSONS NOT RELATED TO YOU:


FIRST & LAST NAME: ________________________________________________________

PHONE# __________________ # OF YEARS AQUAINTED ______

ADDRESS: ________________________________________________________________

TYPE OF BUSINESS OR JOB DESCRIPTION:___________________________________




FIRST & LAST NAME: ________________________________________________________

PHONE# __________________ # OF YEARS AQUAINTED ______

ADDRESS: ________________________________________________________________

TYPE OF BUSINESS OR JOB DESCRIPTION:___________________________________


FIRST & LAST NAME: ________________________________________________________

PHONE# __________________ # OF YEARS AQUAINTED ______

ADDRESS: ________________________________________________________________

TYPE OF BUSINESS OR JOB DESCRIPTION:___________________________________





FOR OFFICE USE ONLY
Licenses and certifications (List, giving dates and sources of issuance):


SKILLS
CHECK the following skills, experiences, etc., which you have:
0 Driver’s License
Number State
0 Chauffeur’s License
Number State
0 Car for use at work
0 Sign Language
0 Foreign language (specify)
0 Adding Machine/calculator
0 Typing (specify WPM)
0 Shorthand/speedwriting (specify WPM)
0 Legal transcription
0 Medical transcription
0 Braille
0 Word Processing
0 Other

Have you ever been convicted of an offense against the law other than a minor traffic violation? (A conviction does not mean you cannot be hired. The offense and how recently you were convicted will be evaluated in relation to the job for which you are applying.) 0 YES 0 NO (If yes, explain fully on an additional sheet.)
WORK HISTORY (include volunteer experience) Use Additional Sheets if Necessary
Current or Last Employer:

Address:


Job Title:

Supervisor’s Name

Telephone Number

No. Supervised by you:


Date Employed (mo/yr)

Starting Salary
$ per
Ending or Current Salary
$ per
Reason for Leaving

May We Contact Employer
YES 0 NO 0

Date Separated (mo/yr)

Full Time Years Months

Part Time Years Months

If part time, number of hours worked per week:
List major duties in order of their importance in the job:


Employer:

Address:


Job Title:

Supervisor’s Name

Job Title:



Date Employed (mo/yr)

Starting Salary
$ per
Date Employed (mo/yr)

Ending Salary
$ per

Date Separated (mo/yr)

Full Time Years Months

Part Time Years Months

If part time, number of hours worked per week:
List major duties in order of their importance in the job:


Employer:

Address:


Job Title:

Supervisor’s Name

Job Title:



Date Employed (mo/yr)

Starting Salary
$ per
Date Employed (mo/yr)

Ending Salary
$ per

Date Separated (mo/yr)

Full Time Years Months

Part Time Years Months

If part time, number of hours worked per week:
List major duties in order of their importance in the job:


I certify that I have given true, accurate and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application, disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications


Signature of Applicant (unsigned applications will not be processed)
Date









Acknowledgement and Authorization for Criminal Background Check

As a condition of my candidacy for employment with One Price Uniforms, Inc DBA Miami Uniforms and More, I understand that One Price Uniforms, Inc will conduct a criminal background check on me for employment purposes.

By signing this Acknowledgement and Authorization, I authorize One Price Uniforms, Inc and /or any other company
authorized by the One Price Uniforms, Inc, to access such information as may be necessary to complete a
criminal background check.

I release from liability all persons and entities supplying such information. I indemnify One Price Uniforms, Inc,
and/or other company authorized by One Price Uniforms, Inc, against any liability which may result from making such requests. I agree that a fax or photocopy of the Acknowledgment and Authorization with my signature will be
accepted with the same authority as the original. I understand that upon my request, I will be given a copy of
the background report and, when applicable, a written description of my rights under the Fair Credit Report Act.

I believe to the best of my knowledge that all information provided below is accurate, true and correct, and that I fully understand the terms of the Acknowledgment and Authorization.


I am a candidate for the position of _____________________________________ at One Price Uniforms, Inc
Hiring Manager’s Name and Extension: Jeanette Angene 305-814-2799
Applicant’s Printed Name: __________________________________________________________
Previous Names known by: _________________________________________________________
Current Address: _________________________________________________________________
City:___________________ State: ____ Zip Code: __________ Country: ___________________
Social Security Number: ______________________ Date of Birth: ________________________
Sex: _______ Race: ________ Drivers License Number and State: _________________________

Signature: ______________________________________ Date: ___________________________