Please list all addresses you have lived at over the past 7 years

Emergency Contact

Please list who you would like us to contact in the event of an emergency.

Personal References

Please list three people not related to you that you have known at least three years.

What hours are you available to work on the following weekdays?

Which of the following categories of jobs have you had? (Select all that apply)

Work Experience

List below your last three employers, starting with your present or last place of employment. You may include in such history any verified work performed on a volunteer basis.

Educational Background

Please list all relevant education history in the following order: High School; College; Trade, Business or Graduate School

Did you Graduate?

Did you Graduate?

Did you Graduate?

Consent to Perform Criminal History Background Check in Compliance with the FCRA (Fair Credit Reporting Act)

This authorization and consent of release acknowledges that MAINSTAY CLEANING (hereafter referred to as "Company" and/or its agent, C4 Operations LLC, may now, or at any time I am enrolled in, assigned to, volunteer with or am employed by Company, conduct investigations whether the records are of a public, private, or confidential nature. These investigations might include, but are not limited to: searches of educational institutions attended; state driving records; financial or credit institutions; employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney-at-law or or other counsel, whether representing me or any other person (in either a civil or criminal case in which i have been involved); records from the U.S. Veterans' Administration; criminal history information on file in local, state or federal agencies; and motor vehicle records, and following and following an employment offer, workers' compensation reports from either the Department of Labor, National Personnel Records or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel Records Center, or any other custodian of my military service record, to release to C4 Operations LLC, the following information and/or copies of documents from my military service record: DD214, service record, and any disciplinary records. I understand that these searches can be used to determine eligibility under the Company policies. Therefore, I authorize the consent for full release of records (either orally or in writing) to the authorized representatives of the Company. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and receive, upon written request, a disclosure of the background report. I also understand that I may request a copy of the report from C4 Operations LLC, by sending a written request to 1201 Edgewood Road SW, Cedar Rapids IA 52404-2344, calling (888) 519-6283 or submiting an email request through the website at www.C4Operations.com. After reading this document, I fully understand its contents and authorize the background verification.