Apply For Job – Peninsula Virginia Apply For Job Rock Solid Employment Application Employment Application Form Personal InformationFirst Name* Middle Initial Last Name* Date* MM slash DD slash YYYY AddressStreet Address* Apartment/Unit # City* State*ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP Code* Is Your Mailing Address different than your home address?* Yes No Mailing AddressStreet Address Apartment/Unit # City State ZIP Code Home PhoneCell Phone*Work PhoneEmail* Email 2 Social Security Number* Are You 18 Years of Age or Older Yes No General InformationPosition Applied for:* General Cleaner Floor Technician Other Other Job Location Applying For Are You a Citizen of the United States* Yes No If no, are you authorized to work in the U.S.? Yes No Have you ever worked for this company?* Yes No If yes, when? Are any relatives or friends currently working for this company?* Yes No Did your friend or relative refer you? Yes No Name of person or company who referred you: Did you graduate High School?* Yes No If no, highest grade completed? 8th 9th 10th 11th Have you ever been convicted of a crime?* Yes No If yes, explain: Have you ever been discharged from any employment or asked to resign* Yes No If yes, explain: Do you currently own your own janitorial business?* Yes No Is it still operational? Yes No Year started? What is your availability? (Check all that apply)* Sun Mon Tues Wed Thurs Fri Sat What times are you available? (Check all that apply)* Days Afternoons Evenings 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?* Yes No Consistent 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?* Yes No If yes, explain: Emergency ContactsEmergency ContactsFirst Emergency ContactFull Name* Phone Number*Relationship* 2nd Emergency ContactFull Name Phone NumberRelationship 3rd Emergency ContactFull Name Phone NumberRelationship Previous Employment 1Company* Phone Number*Address* Supervisor Job Title* Starting Salary*Ending Salary*Responsibilities:* From:* MM slash DD slash YYYY To* MM slash DD slash YYYY Reason for Leaving:* May we contact your previous supervisor for a reference?* Yes No Previous Employment 2Company Phone NumberAddress Supervisor Job Title Starting SalaryEnding SalaryResponsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Previous Employment 3Company Phone NumberAddress Supervisor Job Title Starting SalaryEnding SalaryResponsibilities From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for Leaving: May we contact your previous supervisor for a reference? Yes No Disclaimer and Signature I certify that my answers are true and complete to the best of my knowledge. Signature: (type full name)* Date* MM slash DD slash YYYY Would you like to upload a resume?Max. file size: 50 MB.