We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally protected basis, including, but not limited to, race, age, color, religion, sex, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.
PERSONAL BACKGROUND
LAST NAME:
MI:
FIRST NAME:
CURRENT ADDRESS:
CITY:
STATE:
ZIP:
MAILING ADDRESS:
CELLPHONE #:
EMAIL:
HOW DID YOU HEAR ABOUT THIS JOB?
DO YOU KNOW OR ARE YOU RELATED TO ANYONE WHO WORKS FOR US? YesNo
Driving is a requirement of the job. Is your license valid? YesNo
Do you have full time access to a vehicle? YesNo
Is your vehicle in good working condition? YesNo
Is the vehicle covered by liability insurance? YesNo
Are you able to lift 20lbs or more? YesNo
Would you have difficulty standing, bending, or kneeling in connection with performing necessary cleaning duties? YesNo
Are you allergic to Household Chemicals? YesNo
Are you allergic to cats and/or dogs? YesNo
Are you afraid of cats and/or dogs? YesNo
Day of the Week
Available Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Are you presently employed? YesNo
Which of the following categories of jobs have you had? (Check all that apply) House CleaningHotel/MotelRestaurantFast FoodJanitorialSalesHomemakerManufacturingServiceOther (explain)
Other (Explain):
Date (Month/Year)
Name and address of employer:
Salary
Position
Reasons for leaving
/
Supervisor's name:
Phone number:
EDUCATIONAL BACKGROUND
Name & School Location
Circle Highest Grade Completed
Major Area of Study
High School
None9101112/ GED
College
none1234
Trade, Business, or Graduate School
Have you ever been convicted of a criminal offense? YesNo
If yes, explain:
Have you ever been bonded? YesNo
Has your driver’s license ever been suspended? YesNo
Note: Due to the security-sensitive nature of the job, all employees are required to be bonded. As a matter of policy, the company conducts a police background and driving record check on any applicant in consideration of hiring.
Why are you interested in working for us, Tarylen Cleaning Services?
Why do you think you are a good fit for this company?
How long do you see yourself working here?
Can you go without smoking for 4 hours?
