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 *

Month Day Year
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Day Time Phone *

Area Code Phone Number
E-mail *
Referred By

First Name Last Name
Date You Are Available to To Work *

Month Day Year
Are you Legally Eligible to Work in the U.S.? *

Yes No
Do you have a valid driver's license? *

Yes No
Are you available for periodic on-call, this is a requirement of the position? *

Yes No
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. *

Yes No
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? *

Yes No
If hired, do you have a reliable means of transportation? *

Yes No
Have you ever been convicted of a felony, a background check is required? *

Yes No
If yes, please explain
Have you ever been convicted of any other crime in the past 10 years, excluding minor traffic offenses? *

Yes No
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 Code Phone Number
Reason for Departure *
Duties *
Start Date *

Month Day Year
End Date

Month Day Year
May we contact this employer? (please check one) *

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

Area Code Phone Number
Reason for Departure
Duties
Start Date

Month Day Year
End Date

Month Day Year
May we contact this employer? (please check one)

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

Area Code Phone Number
Reason for Departure
Duties
Start Date

Month Day Year
End Date

Month Day Year
May we contact this employer? (please check one)

YES NO
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 *

Expert Competent Some None
Drywall, including texturing *

Expert Competent Some None
Sub-floor repair/replacement *

Expert Competent Some None
Fence repair *

Expert Competent Some None
Concrete *

Expert Competent Some None
Replace light ballasts *

Expert Competent Some None
Stair/deck repair *

Expert Competent Some None
Roofing repairs *

Expert Competent Some None
Water heater repair/replacement *

Expert Competent Some None
Plumbing repairs *

Expert Competent Some None
Drain stoppages/cleaning *

Expert Competent Some None
HVAC repairs *

Expert Competent Some None
Appliance repairs/replacement *

Expert Competent Some None
Painting *

Expert Competent Some None
Install tile *

Expert Competent Some None
Boiler-zone repair / replacement *

Expert Competent Some None
Repair / Replace lawn sprinkler heads *

Expert Competent Some None
Operate electrical testing meter *

Expert Competent Some None
Pool maintenance / repairs *

Expert Competent Some None
Pool certified? *

Yes No
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 Code Phone Number
Reference (2) Name *
Reference (2) Telephone *

Area Code Phone Number
Reference (3) Name *
Reference (3) Telephone *

Area Code Phone 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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