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? Yor[N

Are you over the age of 18? ] Y or [ N

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

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? Y orN

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

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? YN or

[] 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.