Maintenance Job Application Form

BENDER MIDWEST PROPERTIES IS AN EQUAL OPPORTUNITY EMPLOYER. WE DO NOT DISCRIMINATE ON THE BASIS OF RACE, RELIGION, COLOR, SEX, AGE, NATIONAL ORIGIN, MARITAL STATUS, MILITARY STATUS, OR DISABILITY.
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Application Date*

MonthDayYear
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Day Time Phone*

Area CodePhone Number
E-mail*
Referred By

First NameLast Name
Date You Are Available to To Work*

MonthDayYear
Are you Legally Eligible to Work in the U.S.?*

YesNo
Do you have a valid driver's license?*

YesNo
Are you available for periodic on-call, this is a requirement of the position?*

YesNo
Are you able to meet the physical demands of the position? This position requires work in cramped positions for extended periods of time, work on hands and knees, and reaching with hands and arms. Employees are regularly required to stand, walk, sit, stoop, kneel, crouch, climb stairs, ladders, and talk or hear. Employees must regularly lift and/or move up to 75 pounds and frequently lift and/or move up to 25 pounds.*

YesNo
Maintenance technicians are expected to own, and replace as needed, their own basic hand tools and small electronic tools. If hired, can you meet this requirement?*

YesNo
If hired, do you have a reliable means of transportation?*

YesNo
Have you ever been convicted of a felony, a background check is required?*

YesNo
If yes, please explain
Have you ever been convicted of any other crime in the past 10 years, excluding minor traffic offenses?*

YesNo
If yes, please explain. A "yes" answer will not automatically disqualify your from employment. Rather, such factors as age, dave of conviction, seriousness, nature of the crime, and rehabilitation will be considered.
How did you hear about this position / Referred By:
WORK HISTORY / EXPERIENCE

Please list your 3 most current work history/experience
Employer's Name (Most current)*
Position Held*
Supervisor's Name*
Telephone*

Area CodePhone Number
Reason for Departure*
Duties*
Start Date*

MonthDayYear
End Date

MonthDayYear
May we contact this employer? (please check one)*

YESNO
If NO, reason why not
(2) Employer's Name
Position Held
Supervisor's Name
Telephone

Area CodePhone Number
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
May we contact this employer? (please check one)

YESNO
If NO, reason why not
(3) Employer's Name
Position Held
Supervisor's Name
Telephone

Area CodePhone Number
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
May we contact this employer? (please check one)

YESNO
If NO, reason why not
MAINTENANCE SKILLS:

Please indicate your experience level for each skill below. The skills noted below are not necessarily required for all positions and all skills may not be listed.
Door & screen repair replacement*

ExpertCompetentSomeNone
Drywall, including texturing*

ExpertCompetentSomeNone
Sub-floor repair/replacement*

ExpertCompetentSomeNone
Fence repair*

ExpertCompetentSomeNone
Concrete*

ExpertCompetentSomeNone
Replace light ballasts*

ExpertCompetentSomeNone
Stair/deck repair*

ExpertCompetentSomeNone
Roofing repairs*

ExpertCompetentSomeNone
Water heater repair/replacement*

ExpertCompetentSomeNone
Plumbing repairs*

ExpertCompetentSomeNone
Drain stoppages/cleaning*

ExpertCompetentSomeNone
HVAC repairs*

ExpertCompetentSomeNone
Appliance repairs/replacement*

ExpertCompetentSomeNone
Painting*

ExpertCompetentSomeNone
Install tile*

ExpertCompetentSomeNone
Boiler-zone repair / replacement*

ExpertCompetentSomeNone
Repair / Replace lawn sprinkler heads*

ExpertCompetentSomeNone
Operate electrical testing meter*

ExpertCompetentSomeNone
Pool maintenance / repairs*

ExpertCompetentSomeNone
Pool certified?*

YesNo
We DO NOT consider OR interview anyone who cannot provide 3 references (work, education or church related). NO FAMILY MEMBERS.
Reference (1) Name*
Reference (1) Telephone*

Area CodePhone Number
Reference (2) Name*
Reference (2) Telephone*

Area CodePhone Number
Reference (3) Name*
Reference (3) Telephone*

Area CodePhone Number
Applicant Statement

I certify that all information I have provided in order to apply for and secure work with Bender Midwest Properties is true, complete and correct.If any information provided by me is found to be false, incomplete or misrepresented in any respect,it will be sufficient cause to cancel further consideration of this application, or immediately discharge me from Bender Midwest Properties service, whenever it is discovered.I expressly authorize Bender Midwest Properties and its agents, without reservation, to contact and obtain information from all references,employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information regarding me in this application, resume or job interview. I hereby waive any and all rights and claims I may have regarding Bender Midwest Properties or its agents for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.I understand that Bender Midwest Properties does not unlawfully discriminate in employment, and no question on this application issued for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.I certify that I have read, fully understand and accept all terms of the foregoing Application Statement.Submitting the completed application back to Bender Midwest Properties will be accepted as an electronic signature.
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