Personal Information:

Your Name:     Date:   SS Number:   Email Address:

Residence Address (Street;, City, State, Zip):

Nearest Cross Street:   Home Phone:   Message Phone:

Drivers License #, State & Expiration:    Transportation (Make & year):

Insurance Company:   Type of Coverage:

Vehicle License Number, State:       Driving Record: (# Violations Past 5 Yrs):  

Explain physical limitations that may prevent your from doing this job:

Explain any felony convictions (Will not disqualify applicant):

Have you ever applied with this company before? (When, Where): 

Position Desired: Referred By: Salary Requirements:

Date you can start: Presently Employed? (where, hours)

Can we contact your present employer?  Yes No

U.S. Citizen? Yes No If not, describe authorizing documentation to work

Please indicate days and hours you are available to work:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
From:
To:
Please indicate when your available to work:
Days:   Yes: No:   Evenings:   Yes: No: Late Nights: Yes: No: Weekends:  Yes: No:
Holidays:  Yes: No: On Call:  Yes: No:   Part Time:  Yes: No: Full Time: Yes: No:
Type of Experience:
(Check all that apply)
Office Cleaning  Clean Rooms Floor Waxing Detail Cleaning
Restroom Cleaning Carpet Cleaning Wood Floor Care Construction Cleanup
Re-stocking dispensers Upholstery Cleaning Marble Floor Care Restaurant Cleaning
Vacuuming Window Washing Day Porter Services Light Bulb Replacement
Dusting High Window Cleaning Supervision Light Fixture Repair
Trash Removal Pressure Washing Inspections Light Plumbing
House Cleaning Landscaping Training Painting
Route Work Graffiti Removal Locker Room Cleaning RR Dispenser Repair
Medical Offices Floor Stripping Team Cleaning RR Dispenser Installation
Type of Equipment Used:
(Check all that apply)
Upright Vacuum Extension Poles Floor Machine Pager
Backpack Vacuum Ladders High Speed Buffer Cellular Phone
Dust Mop Window Squeegee Propane Buffer Alarm System
Mop & Bucket Carpet Extractor Automatic Scrubber Webster
Wet Floor Signs CFR Machine Pressure Washer Dusting Cloths

 

Why do you want this job?

What Qualifications and experience will you bring to this job:

How long do you plan to perform this job?

What are your future goals with this company?

Education:
School Level Name & Location Years Graduate Subjects Studied
Grammar
High School
College
Trade, Business, etc.
Previous Employers:
(List last four employers starting with current or most recent, include military service)
Name and Location of Previous Employer: Phone Number:
Position/Title: Starting Date: Leaving Date:
Starting Salary: Leaving Salary:
Supervisor's Name: Description of Work: Reason for Leaving:

Name and Location of Previous Employer: Phone Number:
Position/Title: Starting Date: Leaving Date:
Starting Salary: Leaving Salary:
Supervisor's Name: Description of Work: Reason for Leaving:

Name and Location of Previous Employer: Phone Number:
Position/Title: Starting Date: Leaving Date:
Starting Salary: Leaving Salary:
Supervisor's Name: Description of Work: Reason for Leaving:

Name and Location of Previous Employer: Phone Number:
Position/Title: Starting Date: Leaving Date:
Starting Salary: Leaving Salary:
Supervisor's Name: Description of Work: Reason for Leaving:
References:
Name Phone Number Business Years Acquainted
In Case of Emergency Notify:
Name: Address: Phone Number:

By submitting this application I agree to the following: I authorize investigation of all statements contained in this application.  I understand that misrepresentation or omission of facts called for is cause for dismissal.  Further, I understand and agree that my employment is for no definite period, and may, regardless of the date of payment of my wages and salary, be terminated at any time without cause or any previous notice.