Clean Impact, LLCEmployee Information Form Name Address Phone Number Email Emergency Contact Name and Phone Number Date of Birth Social Security Number Evenings you are available: MondayTuesdayWednesdayThursdayFridaySaturdaySundayPlease check the boxes below to agree to the following: I have received my employee handbook and I understand Clean Impact's rules & policies I agree to allow Clean Impact to run an Illinois State Police background check I understand that all equipment, keys, and shirts are the property of Clean Impact Signature (Please print name) Date of Signature (If you're unable to click the button, please make sure you've filled out all the fields)
