Application Requirement Sheet for Janitorial and Residential Maid
Please read the following list and indicate on the application if you are able to complete the below tasks.
I Requirements (education, training or special abilities):
|
Required |
Helpful |
Comments |
Reading |
X |
|
|
Basic Arithmetic |
X |
|
|
Writing |
X |
|
|
H.S Diploma / G.E.D |
X |
|
|
Vocational Training |
|
X |
|
Previous Experience |
X |
|
|
Driver’s or Chauffeurs License |
X |
|
|
II Working Conditions
|
Yes |
Comments |
Fumes, Odors |
X |
|
Dust |
X |
|
Chemicals |
X |
|
Stress |
X |
|
Outdoors |
X |
|
Noisy |
X |
|
Dangerous Machinery |
|
|
Overtime |
X |
|
Pets: Dogs, Cats etc. |
X |
|
III Physical Demands
|
Required |
Frequently |
Further Description |
Standing |
X |
X |
|
Walking |
X |
X |
|
Lifting |
X |
50 pounds |
|
Carrying |
X |
50 pounds |
|
Climbing |
X |
X |
|
Balancing |
X |
X |
|
Hearing |
X |
X |
|
Talking |
X |
X |
|
Seeing |
X |
X |
|
Sitting |
X |
X |
|
Reaching |
X |
X |
|
Handling |
X |
X |
|
Finger Dexterity |
X |
X |
|
Feeling |
X |
X |
|
Pushing |
X |
X |
|
Pulling |
X |
X |
|
Bending |
X |
X |
|
Twisting |
X |
X |
|
Stooping |
X |
X |
|
Kneeling |
X |
X |
|
Crouching |
X |
X |
|
Crawling |
X |
X |
|
|
