Personal Information
Application Code (use "NOCODE" if you don't have one)
First Name Middle Last Name
Street Address Apt.
City State Zip
Contact Phone Home  Cell  Other  
Contact Phone Home  Cell  Other  
E-mail
Do you have a social security number or an INS document that allows you to work in the United States? Yes  No  
Are you at least 18 years of age? Yes  No  
Have you ever been convicted of a felony, DUI, DWI, or possession of narcotics, or are you currently on probation? Yes  No  
If yes, please explain below.
What means of transportation do you have?
Own vehicle  Friend  Bicycle  Walk  Other  
Do you currently have a valid driver's license? Yes  No  
If No, have you ever had a valid driver's license? Yes  No  
If Yes, explain why not currently:
Do you have floor cleaning experience? Yes  No  
If yes, where, when and what equipment did you use?
Are you available to work on nights and weekends? Yes  No  
Position Sought
Available Start Date
What is the longest you held a job? When and where?
Are you currently employed? Yes  No  Part-time  Full-time  
If Yes, where and for how long?
Days and hours worked?
If Not currently employed, who was the last employer, when, and why not there now?
Additional Questions
Do you smoke? Yes  No  
If yes, can you go without smoking for 4 to 6 hours? Yes  No  
Do you have a problem working alone, locked in a building with security cameras? Yes  No  
Are you currently a member of the National Guard or any other military branch? Yes  No  
Can you lift 50 pounds? Yes  No  
Can you read and write English well enough to communicate with customers?
Yes  No  
Why do you want this job?