Toledo Building Services

All hired employees will be required to complete a Police Records Check form.

PRE-EMPLOYMENT QUESTIONNAIRE

Qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a disability, so long as that disability does not impair their ability to perform the essential functions of the job with or without reasonable accommodations.

Today's Date:

Date

Last Name:

First Name:

Middle Initial:

Social Security Number:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number:

Format: (000) 000-0000.

Have you ever been employed here before?

When?

Under what name?

Why did you leave?

Are you presently employed?

Where?

How long?

Do you have reliable personal transportation to go between job sites during the workday?

Are you avilable to work...

Conviction of a law violation will not necessarily bar you from a job but will be considered in the employment decision. Police record checks are processed on all new employees.

Have you ever been convicted of any law violation (except minor traffic violations)?

If yes, give particulars and dates:

Completed years of schooling:

If you are an experienced operator of any cleaning equipment, please list:

AFFIRMATIVE ACTION

Toledo Building Services Co. takes measures that all applications for employment (and employees) are treated equally, without regard to race, color, religion, gender, national origin, veterans’ status, or disability.

In order for us to comply with the record keeping requirements of our affirmative action plan, we ask that you fill out this form. This information is gathered solely for record keeping and affirmative action purposes and will be kept separate from your employment application. Submissions of the information is voluntary and is not a condition of employment with Toledo Building Services Co.

Sex:

Race/Ethnic Group:

Check if available:

Were you personally referred by someone for this job?

Who referred you?

Is that person a TBS employee?

Do you have a physical condition which would necessitate your needing special equipment or assistance in order to perform the posted essential functions of the position you are applying for? If so, what accommodations would you require?

In Emergencies, notify:

Name & Relationship

Emergency Contact - Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact - Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

In the space below, account for all time for the past three years whether working or not. Include military service and any periods of unemployment. Give complete names, addresses, and dates of employment. If SELF-EMPLOYED, give the name of your business and one reference.

Employment Record:

RELEASE

IN ACCORDANCE WITH THE FREEDOM OF INFORMATION ACT (5 USC 552), THE PRIVACY ACT (5 USC 552A) AND THE FAIR CREDIT REPORTING ACT (PUBLIC LAW 91-508, TITLE VI), OR ANY STATE OR LOCAL LAW DESIGNED TO ABRIDGE DISSEMINATION OF PERSONAL INFORMATION, I EXPRESSLY AUTHORIZE ANY PERSON ASSOCIATED WITH ANY EDUCATIONAL INSTITUTIION, PAST OR PRESENT EMPLOYER, ANY LAW ENFORCEMENT AGENCY FED/STATE/LOCAL, AND CREDIT BUREAU, OR ANY PERSON WHO HAS PERSONAL KNOWLEDGE OF MY CHARCTER, WORK EXPERIENCE, CRIMINIAL RECORDS, EDUCATION, AND OVERALL MODE OF LIVING TO RELEASE THIS INFORMATION TO THE TOLEDO WINDOW CLEANING & JANITOR SERVICE CO., FOR THE PURPOSE OF BEING CONSIDERED FOR EMPLOYMENT WITH ABOVE SAID COMPANY. I RELEASE ALL PERSONS FROM LIABILITY AS A RESULT OF TRUE ACCURATE INFORMATION. I ALSO AUTHORIZE THAT A COPY OF THIS RELEASE BE AS VALID AS AN ORIGINAL.

CERTIFICATION