| 1. Date of Application:
|
2. Name in Full
- First, Middle, Last:
|
3. Phone Number that you can be reached at:
|
| |
|
|
| 4. Social Security Number
|
|
| 5. Present Address
|
6. City
|
7. State
|
8. Zip Code
|
|
|
|
|
| 9. Previous Address for last 3 years:
|
|
| 10. Are you over 18 years of age?
|
| Yes
No
|
| 11. Highest Education Level Completed?
|
|
| 12, Do you own a vehicle to get to work?
|
| Yes
No
Sometimes
|
| 13. You have been given a brief job description, are you able to safely perform these tasks? (see website)
|
| Yes
No
Maybe
|
| 14. If no, what accommodations could Neat Street make which would enable you to perform the job functions properly and safely?
|
|
| 15. Name of person to be notified in case of emergency:
|
|
| 16. Emergency contacts phone number:
|
|
| 17. Are you able to work Full Time?
|
| Yes
No
|
| 18. Which shift 8:00a to 4:30p or 4:30p to ?
|
|
| 19. Are you able to work Part Time?
|
| Yes
No
|
| 20. Which shift 8:00a to 4:30p or 4:30p to ?
|
|
| 21. How many hours do you desire to work: 10-20, 20-30, 30-40, other?
|
|
| 22. Are you available to work weekends?
|
| Yes
No
Sometimes
|
| 23 What wage do you expect to receive?
|
|
| 24. Employment History: List name, address, phone number, dates worked, in date from previous employer first:
|
|
| 25. Employer #2:
|
|
| 26. Employer #3:
|
|
| 27. References: Name 3 persons, other than relatives, former employers, include what your affiliation is with them, address and phone number:
|
|
| 28. Reference #2:
|
|
| 29. Reference #3:
|
|
| 30. Reference #4:
|
|
| 31. Have you ever swept? with what?
|
|
| 32. Have you ever mopped?, with what?
|
|
| 33. Have you ever carpet cleaned? with method?
|
|
| 34. Have you ever window cleaned? with what and what products?
|
|
| 35. Have you ever disinfected a restroom? commercial or residential?
|
|
| 36. Have you ever stripped floors?
|
| Yes
No
|
| 37. Have you ever finished floors?
|
| Yes
No
|
| 38. Have you ever used a high speed burnisher?
|
| Yes
No
|
| 39. Have you ever used a buffer?
|
| Yes
No
|
| 40. Have you ever team cleaned?
|
| Yes
No
|
| 41. Have you ever cleaned professionally on your own?
|
|
| 42. Have you been trained? explain:
|
|
| 43. Have you ever operated a calculator?
|
| Yes
No
|
| 44. Have you ever operated a typewriter?
|
| Yes
No
|
| 45. Have you ever operated a computer? If so, what programs have you worked with?
|
|
| 46. Have you ever used a multi-line phone?
|
| Yes
No
|
| 47. Have you ever done telemarketing?
|
| Yes
No
|
| 48. List any other secretarial work?
|
|
| 49. Are you currently advertising to clean?
|
| Yes
No
|
| 50. Are you currently cleaning for someone else?
|
|
| 51. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
|
| Yes
No
|
| 52. Has any license, permit or privilege ever been suspended or revoked?
|
| Yes
No
|
| 53. If the answer to either question 50 or 51 is yes, please give a statement giving details:
|
|
| 54. Have you ever been convicted of a crime other than minor traffic violations?
|
| Yes
No
|
| 55. If yes, explain fully. A criminal conviction will not necessarily be a bar to employment. Any relevant factors such as age at time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.
|
|
| 56. Equal Employment Opportunity Policy: Applicants are considered for all positions without regard to race, color, religion, sex, national origin, are, marital or veteran status, or the presence of a non-job related medical condition or handicap.
|
|
| 57. I authorize investigation of all statements contained in the attached application. I understand that misrepresentation of omission of facts called for is cause for dismissal. (yes or no)
|
|
| 58. I have read and understood questions 56 and 57.
|
| Yes
No
|
| 59. The following is strictly for informational purposes only. You are under no obligation to answer any of the following questions.
|
|
| 60. Have you applied for a position with our company in the past?
|
|
| 61. Are you working now?
|
|
| 62. When could you begin work at our company?
|
|
| 63. What type of relationship do you have with your supervisor in your present (or last) position?
|
|
| 64. Have you ever been fired? If so why?
|
|
| 65. Would your previous employer rehire you if you applied and a position was open?
|
|
| 66. How many days have you been absent from work for any reason in the past year?
|
|
| 67. How many times have you been late for work for any reason in the past year?
|
|
| 68. How will your supervisor rate your performance on your present (or last) job?
|
|
| 69. Have you ever supervised the work of others?
|
|
| 70. Do you consider yourself the best at what you do at work?
|
|
| 71. Do you prefer to work as a team or alone?
|
|
| 72. How do you plan to get to work on a daily basis?
|
|
| 73. What are you looking for in a job?
|
|
| 74. Is the location of your assigned building important to you?
|
|
| 75. Are you willing to commute across town to work at a location?
|
|
| 76. If, not how far are you willing to travel?
|
|
Your Name:
Your Email:
|
