Have you ever applied to / worked for Wheeler's Janitorial before? ]Yor[]N If yes, please explain (include date):

Do you have any friends, relatives, or acquaintances working for Wheeler's Janitorial? [ Y orN If yes, state name & relationship:

If hired, would you have transportation to/from work? 

Are you over the age of 18? 

If you are under the age of 18, do you have an employment/age certificate?

If hired, would you be able to present evidence of your U.S. citizenship or proof of your legal right to work in the United States? 

Have you been convicted of or pleaded no contest to a felony within the last five years?

If yes, please describe the crime - state the nature of the crime(s), when and where convicted, and the disposition (final settlement) of the case:

If hired, are you willing to submit to a controlled substance test? 

[] Temporary work - such as summer or holiday work? Y orN Regular part-time work? Y or [N N Regular full-time work? []Yor[

If applying for temporary work, indicate your desired length of employment below:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

[] Are you available to work overtime? [ ] YorN

If hired, on what date can you start working?

Are you able to perform the essential functions of the job for which you are applying, either with / without reasonable accommodation? [] Y orN

If no, describe the functions that cannot be performed:

Education, Training and Experience

Number of years completed: Did you graduate? Y orN Degree / Diploma earned:

College / University: School Name:

Number of years completed: Did you graduate? Y or [ Degree / Diploma Earned:

Number of years completed: Did you graduate? Y or Degree / Diploma earned:

Rank in Military: Total Years of Service: Skills/Duties:

Skills and Qualifications: Licenses, Skills, Training, Awards

Do you speak, write or understand any foreign languages? Y or[N

If yes, list which languages(s) and how fluent you consider yourself to be:

You should be prepared to detail each position for the past five years and account for any gaps in employment during that period.

[] Are you currently employed? [] Y orN

If you are currently employed, may we contact your current employer?

Salary/Hourly Rate of Pay: Position & Duties:

Name of Employer: Name of Supervisor:

Salary/Hourly Rate of Pay: Position & Duties:

May we contact this employer for references? [ ] Yor[N

Salary/Hourly Rate of Pay: Position & Duties:

May we contact this employer for references? (] Y or[N

List below three persons who have knowledge of your work performance within the last four years. Please include professional references only.

City, state, zip: Occupation: Number of Years Acquainted:

City, state, zip: Occupation: Number of Years Acquainted:

City, state, zip: Occupation: Number of Years Acquainted:

Icertify that the 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 if I am hired. I authorize the verification of any and all information listed above.