Please enable JavaScript in your browser to complete this form.Applicant InstructionsIf you need help filling out this application form or for any phase of the employment process, please notify us at Mark@VisibleDifferenceJanitorial.com every effort will be made to accommodate your needs in a reasonable amount of time. 1. Please read "APPLICANT NOTE" below. 2. Complete both sides of this page. 3. If more space is needed to complete any question, use comments section at the bottom of this page. 4. Some packets may include an AFFIRMATIVE ACTION QUESTIONNAIRE, This infonnation is being gathered for affirmative action under Section 503 of the Rehabilitation Act of 1973. The information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire. ( APPLICANT NOTE) This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview and on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin or the presence of disabilities. A felony conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. After an offer of employment, and prior to reporting to work, you are required to submit to a medicai review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company. Date / Time *DateTimeName *FirstLastEmail *Cell Phone *Home Phone *Current Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrior AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAvailabilityFor which position are you applying for? *What date can you start? *What category would you prefer?Full-timePart-timeTemporaryLabor poolWhich schedule would you prefer? *WeekdaysWeekendsEveningsNightsOvertimeShiftJob Related SkillsNOTE: Do not fill out any part of this section you believe to be non-job related.If the job requires, do you have the appropriate valid drivers license? *YesNoName on licenseFirstLastDrivers License #TypeState of IssueHave you had any moving violations?YesNoPlease DescribePlease list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or company.Have you been given a job description, viewed it on our site or had the requirements of the job explained to you? *YesNoDo you understand these requirements?YesNoCan you perform requirements of this job with or without reasonable accommodation?YesNoList languages in which you are fluent.SecurityList states and counties of residence for the past seven years.Have you worked for another company under another name? *YesNoNameFirstLastHave you been convicted of, or served time for a felony in the past seven years? If so, please describe in the fields below. *YesNo(In accordance with company policy this information will be reviewed for job relatedness and time since last conviction)IncidentCity/StateChargeDate of ConvictionAny other convictions?YesNoIncidentCity/StateChargeDate of ConvictionJob Application CommentsPrevious EmployersPLEAE NOTE. Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. Ask for a phone book or call information if necessary. FOR EMPLOYERS OUTSIDE THE U.S., A CURRENT FAX NUMBER IS MANDATORY. Most Recent EmployerCompany NameAre you still working for this employer?YesNoIf yes, may we contact?YesNoPhoneFaxAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStart DateEnd DateJob TitleDutiesSupervisor NameFirstLastSalary (per Hour, Week, Month)Reason For LeavingSecond Most Recent EmployerCompany NamePhoneFaxAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStart DateEnd DateJob TitleSupervisor NameFirstLastDutiesSalary (Per Hour, Week, Month)Reason For LeavingThird Most Recent EmployerCompanyPhoneFaxAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeStart DateEnd DateJob TitleSupervisor NameFirstLastDutiesSalary (Per Hour, Week, or Month)Reason For LeavingReference 1.NameFirstLastPhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYears KnownRelationshipReference 2.NameFirstLastPhoneAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYears KnownEducationPlease select highest grade completed. *7891011121314151616+High SchoolCity/StateDid you graduate?YesNoDegreeCollegeCity/StateDid you graduate?YesNoDegreeOther EducationApplication Questions1. Tell me about yourself. Please include your strengths and weaknesses. *2. Do you have reliable transportation? *YesNo3. Do you have a cell phone? *YesNo4. Have you ever worked for a janitorial/cleaning service before? *YesNoIf yes, tell me about it.5. Why are you leaving your current job (if applicable)? What did you like/dislike about that job? *6. Have you had any problems with managers/supervisors in previous employment? If so, explain what happened? How did you deal with a difficult customer? *Certification and Release I certify that I have read and understand the applicant note on page one of this form and that the answes given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and/ or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. Signature *Clear SignatureDate / Time *DateTimeSubmit