Apply For Job – Glen Allen, Virginia Apply For Job Rock Solid Employment Application Employment Application Form Personal InformationLast Name*First Name*Middle InitialDate* AddressStreet Address*Apartment/Unit #City*State*ZIP Code*Is Your Mailing Address different than your home address?*YesNoMailing AddressStreet AddressApartment/Unit #CityStateZIP CodeHome PhoneCell Phone*Work PhoneEmail*Email 2Social Security Number*Are You 18 Years of Age or OlderYesNoGeneral InformationPosition Applied for:* General Cleaner Floor Technician Other OtherJob Location Applying ForAre You a Citizen of the United States*YesNoIf no, are you authorized to work in the U.S.?YesNoHave you ever worked for this company?*YesNoIf yes, when?Are any relatives or friends currently working for this company?*YesNoDid your friend or relative refer you?YesNoName of person or company who referred you:Did you graduate High School?*YesNoIf no, highest grade completed?8th9th10th11thHave you ever been convicted of a crime?*YesNoIf yes, explain:Have you ever been discharged from any employment or asked to resign*YesNoIf yes, explain:Do you currently own your own janitorial business?*YesNoIs it still operational?YesNoYear started?What is your availability? (Check all that apply)* Sun Mon Tues Wed Thurs Fri Sat Days Afternoon Evening Commercial cleaning requires that you repeatedly stand, stoop, kneel, bend, lift (up to 40lbs.), push and pull equipment, extend your arms and/or reach above your head. Are you able to perform these essential job functions?*YesNoConsistent attendance and punctuality are essential requirements of every job with this company? Is there anything which would interfere with your regular attendance and punctuality if you are offered a job with this company?*YesNoIf yes, explain: Emergency ContactsEmergency ContactsFirst Emergency ContactFull Name*Phone Number*Relationship*2nd Emergency ContactFull NamePhone NumberRelationship3rd Emergency ContactFull NamePhone NumberRelationshipPrevious Employment 1Company*Phone Number*Address*SupervisorJob Title*Starting Salary*Ending Salary*Responsibilities:*From:* To* Reason for Leaving:*May we contact your previous supervisor for a reference?*YesNoPrevious Employment 2CompanyPhone NumberAddressSupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesFrom To Reason for Leaving:May we contact your previous supervisor for a reference?YesNoPrevious Employment 3CompanyPhone NumberAddressSupervisorJob TitleStarting SalaryEnding SalaryResponsibilitiesFrom To Reason for Leaving:May we contact your previous supervisor for a reference?YesNoDisclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. Signature: (type full name)*Date* Would you like to upload a resume?
