Application | Employment

Ability Assessment

I have a valid driver's license.

I have a phone number where I can be contacted.

I have not been convicted of any felonious crimes.

I have reliable transportation.

I am willing to take and will pass a drug test.

I am able to lift up to 50 lbs.

Please enter any additional information.

Employment Application

Full Name (First, Middle, Last) *

Address *

Street Address

Address Line 2

City

State / Province / Region

Zip / Postal Code

Education

Please list all schools attended beginning with the most recent.

Skill & Qualifications: Licenses, Skills, Training Awards

Name & Address of School - Degree/Diploma - Graduation Date

Military Service Record

Have you ever served in the U.S. Armed Forces? *

If yes, please complete the following information:

Branch of Service:

Rank/Type of Service:

Dates of Service:

Special Training/Experience:

Employment History

Do you have any previous janitorial/cleaning experience? *

If yes, please explain.

Please list your work experience beginning with your most recent job held. If you were self-employed, give the company’s name.

Employer One

Employer

Supervisor

Email

Salary

Employment Dates

May we contact this employer?

Address

Phone

Position

Responsibilities

Reason For Leaving

Employer Two

Employer 2

Supervisor

Email

Employment Dates

Salary

May we contact this employer?

Address

Phone

Position

Responsibilities

Reason For Leaving

Employer Three

Employer 3

Supervisor

Email

Employment Dates

Salary

May we contact this employer?

Address

Phone

Position

Responsibilities

Reason For Leaving

References and Approval

Please list at least two (2) references that are NOT relatives or previous employers.

Reference Name/Title/Address/Phone

I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above.

Initials *

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