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?*

FacebookIndeed/ZipRecruiterCurrent EmployeeOtherOther
Did a current employee refer you to this position?

YesNo
If yes, who?
Name of person who referred you
Available start date:*

MonthDayYear
What is your current employment status?*

EmployedUnemployedSelf-EmployedStudent
Desired Wage (hourly)
Are you a U.S. Citizen?

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Have you ever worked for Aqua Power Pros/First Impressions?

YesNo
If yes, when?
Have you ever been convicted of a felony?

YesNo
If yes, explain:
Do you have a valid driver's license?*

YesNo
If No, do you have other reliable transportation?*

YesNo
Hours of Availability
I am available:

Full-TimeEveningsPart-TimeWeekends
Education
High School:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years You Attended
Did you graduate?

YesNo
Diploma:
College:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Years You Attended
Did you graduate?

YesNo
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?

YesNo
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?

YesNo
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