Wheeler's Janitorial Application

First Name*

Middle Name

Last Name*

Street Address*

City, State, Zip Code*

Phone Number*

Please enter a valid phone number.

Email Address*

example@example.com

Email Address*

example@example.com

Have you ever worked for Wheeler's Janitorial before?

YesNo

If yes, when?

Do you have any friends, relatives, or acquaintances working for Wheeler's Janitorial?

YesNo

If yes, state name, relationship and location.

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

YesNo

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?*

YesNo

Have you been convicted (found guilty) of or pleaded no contest to a felony within the last five years?*

YesNo

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 no, please enter N/A.*

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

YesNo

Position Applying For

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Temporary/Seasonal Work - such as summer or holiday workRegular Part-time work

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Hours Available: from

[] 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

School Name

School Address

School City, State, Zip

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

Number of years completed

Degree / Diploma earned

College / University: School Name:

School Name

School Address

School City, State, Zip

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

Number of years completed

Degree / Diploma Earned

School Name

School Address

School City, State, Zip

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

Number of years completed

Degree / Diploma earned

Branch

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

Rank in Military

Total Years of Service

Skills/Duties

Related Details

Skills and Qualifications: Licenses, Skills, Training, Awards

Skills and Qualifications

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?

Name of Employer: Name of Supervisor: Telephone Number: Business Type: Address: City, State, Zip

Name of Employer

Name of Supervisor

Business Type

Address

City, State, Zip

Length of Employment (Include Dates)

Date

Salary/Hourly Rate of Pay: Position & Duties:

Salary/Hourly Rate of Pay

Position & Duties

Name of Employer: Name of Supervisor:

Name of Employer

Name of Supervisor

Telephone Number: Business Type: Address

Business Type

Address

City, State, Zip

Length of Employment (Include Dates)

Date

Salary/Hourly Rate of Pay: Position & Duties:

Salary/Hourly Rate of Pay

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

Name of Employer: Name of Supervisor: Telephone Number: Business Type

Name of Employer

Name of Supervisor

Business Type

Address

Street Address Line 2

City, State, Zip

Length of Employment (Include Dates)

Date

Salary/Hourly Rate of Pay: Position & Duties:

Salary/Hourly Rate of Pay

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.

First and Last Name

Telephone Number: Email Address

Email Address

example@example.com

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

Address

Street Address Line 2

City, state, zip

Occupation

Number of Years Acquainted

First and Last Name

Telephone Number: Email Address

Email Address

example@example.com

Address

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

City, state, zip

Occupation

Number of Years Acquainted

First and Last Name

Telephone Number: Email Address

Email Address

example@example.com

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

Address

Street Address Line 2

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.

Signature

Date

Phone Number

Please enter a valid phone number.