Job Application *required fields Applicant Information Applicant Name* Date* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--District of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands Zip Code* Phone Number* Email* Employment Position Position(s) Applying For* On what date can you start working if you are hired?* What days are available for work?* What hours or shift are you available for work* If needed, are you available to work overtime?*YesNo Do you have reliable transportation to and from work?*YesNo Salary desired Personal Information Are you 18 years of age or older?*YesNo Are you a U.S. citizen or approved to work in the United States?*YesNo Will you consent to a mandatory controlled substance test?*YesNo Do you have any condition which would require job accommodations?*YesNo Have you ever been convicted of a criminal offense (felony or misdemeanor)?*YesNo (Note: No applicant will be denied employment solely on the grounds of a conviction of a criminal offense. The date of the offense, the nature of the offense, including any significant details that affect the description of the event and the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however be considered.) (Note: Safe & Clean Maintenance complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Education and Training High School Name Location (City, State) Year Graduated Degree Earned College/University Name Location (City, State) Year Graduated Degree Earned Vocational School/Specialized Training Name Location (City, State) Year Graduated Degree Earned Military Are you a member of the Armed Services? What branch of the military did you enlist? What was your military rank when discharged? How many years did you serve in the military? What military skills do you possess that would be an asset for this position? Previous Employment Employer Name Job Title Supervisor Name Employer Address City, State and Zip Code Employer Telephone Dates Employed Reason for Leaving Employer Name Job Title Supervisor Name Employer Address City, State and Zip Code Employer Telephone Dates Employed Reason for Leaving Employer Name Job Title Supervisor Name Employer Address City, State and Zip Code Employer Telephone Dates Employed Reason for Leaving References Please provide 3 personal and professional references below: Reference One Reference One Contact Information Reference Two Reference Two Contact Information Reference Three Reference Three Contact Information Please leave this field empty. Upload Your Resume Help us fight spam by providing the correct answer to this question (answer is a two digit number)*. What is 10+2? Submit Application
