EMPLOYMENT APPLICATION
(Incomplete
applications will not be considered)
Date of
Application: Position
Applied for:
Name in
Full (last, first)
S.S.N.: Date
of Birth / / Phone:
Home
Address: City: State: Zip:
Highest
Education Level Completed:
Do you have
any physical condition that may limit your ability to perform the job for which
you have applied?
[ ] Yes [ ] No: If yes, explain
fully
Does heat,
standing on your feet, or lifting cause you any difficulties?
Yes No: If yes, explain
fully
WORK HISTORY
(start with present to last job)
From: To:
Name of Company: Position(s)
Held:
Address: Phone #:
Supervisor: May
we contact: [ ] Yes [ ] No
Reason for leaving:
From: To:
Name of Company: Position(s)
Held:
Address: Phone #:
Supervisor: May
we contact: Yes No
Reason for leaving:
From: To:
Name of Company: Position(s)
Held:
Address: Phone #:
Supervisor: May
we contact: [ ] Yes [ ] No
Reason for leaving:
Indicate languages you speak: Read: Write:
REFERENCES:
(Name three persons other than relatives)
Name: Phone:
Name: Phone:
Name: Phone:
What kind
of janitorial work can you do?
Do you have
reliable transportation? [ ] Yes [ ] No
Have you
ever been convicted of a crime other than minor traffic violations? [ ] Yes [ ] No
If yes,
explain fully. A criminal conviction will not necessarily be a bar to employment. Any relevant factors, such as age at the time
of the offense, seriousness and nature of the violation, and rehabilitation
will be taken into account.
I authorize investigation of all statements
contained in the attached application. I
understand that misrepresentation or omission of facts called is cause for
dismissal.
Signature: Date: