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Application for Employment

First Name (required)

Last Name (required)

Date of Birth (required)

Telephone Number (required)

Permanent Address (required)

City (required)

State (required)

Zip Code

Driver License and Exp. Date

Employment Desired

Date you can start

How did you hear about us?

Position applying for
JanitorBus Cleaner

Are you currently employed?
YESNO

Have you ever worked for this company? If yes, reason for leaving?

Name of the person who referred you?

Shift or hours preferred
Day timeNight time

Do you want to work part-time or full-time?
Part-timeFull-time

Other time

How are you able to get to work?

What special skill do you have? Do you have floor experience?

Do you have any job related physical limitations?
YESNO

Previous Employment

From

TO

Name & Address

Last position

Reason for leaving

In the past two years, have you been denied a position on the basis of a positive drug and alcohol DOT test or refused to take a test?

YESNO

Please indicate years of education completed

Grade School
High School
College
BUS or Trade School
Other (specify)

Personal Reference

Please list 1 non-relative whom you know for one year

Name and Address
Business
Telephone number
Years known

Emergency Contact

Name and Address

Relationship

Telephone number

Years known

I certify all statements to be true and correct and authorize the investigation of all statements contained in this application. I understand that misrepresentations or omissions of facts called for is cause for dismissal

Our Address

5113 Alpine Place, Las Vegas, NV 89107
Phone : (702) 878-8020
Email : info@dlpjanitorial.com
Website : www.dlpjanitorial.com

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