Employment ApplicationStep 1 of 520%Please fill in your first and last name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone number*Cell phone numberEmail address* Are you at least 18 years old?*YesNoWhat date are you available to start?* MM slash DD slash YYYY Have you been given a job description or had the requirements of the job explained to you?*YesNoDo you understand these job requirements?*YesNoCan you perform the requirements of this job without accommodation including regular lifting of 25 pounds and use of a 12 pound back pac vacuum?*YesNoPlease Note:Your application will not be considered unless correct telephone numbers of past employers are included and all information is filled out. If you need help please call and ask.For which position are you applying?* Restroom Specialist Utility Specialist Light Duty Specialist Vacuum Specialist Floor Machine SpecialistList three things that are important to you in your work enviroment:*1. 2. 3. Three characteristics that best describe you:*1. 2. 3. Why do you want to work here?*Please list any classes or workshops you have taken that pertain to the field:*Please list any special interests, hobbies and skills:*Additional information you would like us to know about your values, desires and work ethic:*Are you taking any medication or have any medical conditions that could impact your safety or the safety of others while on the job?* Yes NoIf yes, please explain:*Please check the box below acknowledging that you understand our drug policy.* I understand that this is a DRUG FREE & TOBACCO-FREE FACILITY AND WORK PLACE.Driver's License & Driving InformationDo you have a valid driver's license?* Yes NoIf you don't have a driver's license, why?*What state was your driver's license issued from?*Have you ever been denied a license, permit, or privilege to operate a motor vehicle?* Yes NoHas any license, permit or privelege ever been suspended or revoked?* Yes NoIf Yes, Why did your license or permit get revoked?*Have you been involved in a traffic accident in the past 5 years?* Yes NoIf Yes, what date did the last accident take place?* MM slash DD slash YYYY Where there any injuries in this accident?* Yes NoWhere there any fatalities in this accident?* Yes NoHave you had any traffic convictions and/or forfeitures in the past 5 years (other than parking violations?)*Location: Date: Charges: Penalty: Have you ever been convicted of a felony or misdemeanor?*We run a complete background check before hiring all employees.YesNoIf yes, what were you convicted of?Are you able to stand for 2-3 hours at a time?*This position may require that you are on your feet for extended periods of time.YesNoIf no, please list why you are not able to stand for 2-3 hours at a time.Employer 1 Information ( most recent employer)Employer 1 Name* Employer 1 - Address*Please fill in all information about your most recent employer. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 1 - Phone Number*Employer 1 -How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employeeEmployer 1- Please state reason for your employment ending*Employer 1 - Job title*Employer 1 - Starting pay*Employer 1 - Ending pay?*Employer 1 - Start date?* MM slash DD slash YYYY Employer 1 - End date?* MM slash DD slash YYYY Employer 1 - Describe your duties at this job.*Employer 1 - Supervisor's name?*Employer 1 - Supervisor's phone number?*Employer 1 - Do we have permission to contact this person as a reference?* Yes NoEmployer 2 - (Second most recent)Employer 2 Name* Employer 2 - Address*Please fill in all information about your most recent employer. Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 2 - Phone Number*Employer 2 - How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employeeEmployer 2 - Please state reason for your employment ending*Employer 2 - Job title?*Employer 2 - Starting pay?*Employer 2 - Ending pay?*Employer 2 - Start date?* MM slash DD slash YYYY Employer 2 - End date?* MM slash DD slash YYYY Employer 2 - Describe your duties at this job.*Employer 2 - Supervisor's name?*Employer 2 - Supervisor's phone number?*Employer 2 - Do we have permission to contact this person as a reference?* Yes NoEducationHigh School(s)*Did you graduate from High School?* Yes No I got my GEDDid you attend a college(s) or university(s)?* Yes NoIf Yes, Did you graduate from a college or university?* Yes NoSignature / Disclosure SectionEmployment Rules and Conditions*False Statement = Termination: False information, omissions or misrepresentations of facts, or misleading statements during the interview or on this application may result in reject of my application or discharge if discovered at any time during employment. Not a contract: This application form is intended for use in evaluating your qualifications for employment. This is not an employment contract. Employment at Will Agreement: I agree that, if hired, I will conform to the rules and regulations of this company and further understand and agree that my employment is for no definite period and may, regardless of the time and manner of payment of my wages and salary, be terminated at any time by this company or me, with or without cause or any previous notice. Equal Opportunity Employment: All qualified applicants will receive consideration without discrimination because of sex, marital status, race, age, creed, national origin or the presence of disabilities. Affirmative Action Questionnaire: This information is being gathered for Affirmative Action under section o503 of the Rehabilitation Act of 1973. This information requested is voluntary and will be kept confidential. An applicant will not be subject to any adverse treatment for refusing to complete the questionnaire. Drug and other testing: Additional testing of job-related skills and for the presence of drugs in your body may be required prior to employment. Substance/Alcohol Abuse = IMMEDIATE TERMINATION: I understand that, if hired, I will conform to the regulations concerning drugs and alcohol. Drugs and alcohol use is not permitted. Illegal drug use and alcohol consumption on or before work is grounds for immediate termination. Unable to report to work due to illness or emergency: Please contact your immediate supervisor at least 4-6 hours in advance of your shift start time. Frequent absence is not acceptable and will eventually result in termination. No Show, No Call = Termination: if you do not call to give notice that you will be unable to work your shift (without just cause) you will be terminated. No final paychecks mailed: Until we receive uniforms, building keys, badges, and any other property owned by Grimebusters, Inc., will result in a payroll deduction. Shirts will be deducted at $14.95 each and deductions will accumulate for re-keying locks for the facility (full receipt will be provided) and etc.. Unauthorized visitor in the facility: No children, family or friends may be on job site or in your vehicle at any time. Automated time/attendance policy: The purpose of the time and attendance system is to ensure that all employees are paid accurately and timely. The system will also help provide accountability for the employee and help us to contact the employee in case of emergency. It is your personal responsibility to check into the system daily when at work from a pre-assigned phone line at your facility to clock-in and to clock-out. You may not use your home or cell phone for time clock-ins or clock-outs. Failure to follow these instructions will result in payroll deduction for the time and disciplinary action up to and including termination. Communication log/spiral notebook: The important purpose of communication log/spiral notebook is to maintain and open line of two-way communication between our employee and our customer. The left side is for our customer to provide problems, concerns, and compliments. The right side of the page is for our employee to respond, act, sign-off and initial that you have corrected a problem or acknowledged the comment. If no comments, simply sign-off your cleaning with initials or name and date. Respond to messages in a positive manner. Never be disrespectful in any way to the customer. Alert Grimebusters, Inc. with notification of customer concerns so that supervisors are kept apprised of on-going customer communications. If you feel that you have a problem with a message, please let the office or supervisor know via voice-mail. We will handle the situation. Authorization and release of information: I authorize the company and/or its agents, including consumer reporting bureaus and criminal background investigating organizations, to verify and of this information including, but not limited to, criminal history and motor vehicle driving records. I authorize all persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. Illegal druga and alchohol use: I also understand that the use of illegal drugs and alcohol is prohibited during employment. I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment at Grimebusters, Inc. at any time. I understand and acknowledge that what I have submitted it true and complete. I agree and understand the terms of employment at Grimebusters, Inc.Signature*I understand that by agreeing to the above terms and typing my name here that this is my digital signature. This application will receive active consideration for 30 days upon submission. PhoneThis field is for validation purposes and should be left unchanged.Δ
