Employment Application

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Full Time Janitorial in Annville, Mon-Fri, 9p-5a, $16/hour
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Part Time Janitorial in annville, Sat and Sun, 9p-5a, $16/hour
Full Time Janitorial in Middletown, Mon-Fri, 6a-2:30p, $16/hour

Application For Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status

Name(Required)

First Last

Applicant Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

Date of Birth(Required)

Social Security Number(Required)

If you are under 18 years of age, can you provide required proof of your eligibility to work?

Yes

Have you ever filed an application with us before?

Yes

Are you currently employed

Yes

May we contact your current employer

Yes

Are you prevented from lawfully becoming employed in the US because of visa or immigration status?

Proof of citizenship or immigration status will be required

Yes

When are you available to start work?

Are you available to work:

Full Time

Part Time

Shift Work

Temporary

Shift Preference

1st Shift

2nd Shift

3dr Shift

Are you available to work weekends?

Yes

Are you currently on 'lay-off' status and subject to recall?

Yes

Can you travel if job requires it?

Yes

Have you ever been convicted of a felony within the last 7 years?

Conviction will not necessarily disqualify an applicant from employment

Yes

If Yes, Please Explain

Education

We are an equal opportunity employer

High School - Name and Address

High School - Year Completed

High School - Diploma or Degree

Undergraduate School - Name and Address

Undergraduate School - Year Completed

Undergraduate School - Degree

Graduate School - Name and Address

Graduate School - Year Completed

Graduate School - Degree

Other (Please Specify)- Name and Address

Other (Please Specify) - Year Completed

Other (Please Specify) - Degree

Do you speak a foreign language?

Yes

Can you read a foreign language?

Yes

Can you write a foreign language?

Yes

If yes, please list which languages.

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate gender, race, religion, national origin, age ancestry, disability or other protected status.

Employer Name

Job Title

Employer Phone

Employer Address

Street Address City State / Province / Region ZIP / Postal Code

Supervisor

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Reason for leaving

Start Date

End Date

Please list all duties performed

Employer Name

Job Title

Employer Phone

Employer Address

Street Address City State / Province / Region ZIP / Postal Code

Supervisor

Starting Salary/Hourly Rate

Ending Salary/Hourly Rate

Reason for leaving

Start Date

End Date

Please list all duties performed

References

Name of 1st reference

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Name of 2nd reference

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of 3rd reference

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please state any additional information you feel may be helpful to us in considering your application.

Note to applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied?

Yes

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