Janitorial/Floor Application Form

Applicant Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Position Applying for:
How did you hear about this job?

Other
Did a current employee refer you to this position?
If yes, who?
Name of person who referred you
Available start date:

MonthDayYear
What is your current employment status?
Desired Wage (hourly)
Are you a U.S. Citizen?
If no, are you authorized to work in the U.S.?
Have you ever worked for Aqua Power Pros/First Impressions?
If yes, when?
Have you ever been convicted of a felony?
If yes, explain:
Do you have a valid driver's license?
If No, do you have other reliable transportation?
Hours of Availability
I am available:
Education
High School:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years You Attended
Did you graduate?
Diploma:
College:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years You Attended
Did you graduate?
Degree:
Other Education:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Dates Attended
Degree/Certificate:
Personal References
Full Name

First NameLast Name
Relationship:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Full Name

First NameLast Name
Relationship:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Previous Employment
Company:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Job Title:
Starting Wage:
Ending Wage
Responsibilities:
Years you were employed:
Reason for Leaving:
Supervisor:
May we contact your previous supervisor for a reference?
Company:
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Job Title:
Starting Wage:
Ending Wage
Responsibilities:
Years you were employed:
Reason for Leaving:
Supervisor:
May we contact your previous supervisor for a reference?
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information on my application or interview may result in my release.
Signature

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Applicant Information

Hours of Availability

Education

Personal References

Previous Employment

Disclaimer and Signature