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Commercial Services
Ultrasonic Blind Cleaning
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Carpet Cleaning
Window Cleaning
Green Cleaning
Light Bulb Replacement
Painting
U.S. SERVICO, INC.
PRE-EMPLOYMENT APPLICATION
U.S. SERVICO, INC. IS DEDICATED TO A POLCY OF NON-DISCRIMINATION IN EMPLOYMENT. NO QUESTION IS ASKED FOR THE PURPOSE OF EXCLUDING ANY APPLICANT DUE TO RACE, CREED, COLOR, NATIONAL ORIGIN, RELIGION, AGE, VETERAN STATUS, SEX, MENTAL OR PHYSICAL DISABILITIES, OR ANY OTHER LEGALLY PROTECTED STATUS.
PLEASE FURNISH COMPLETE AND ACCURATE INFORMATION.
Name
*
Address
*
Phone
*
City
State
ZipCode
Email
*
WHAT ARE YOUR TWO MAJOR CROSS STREETS?
What kind of work are you applying for?
What Janitorial experience do you have?
What type of work per week do you prefer?
Part Time
Full Time
What Days Are You Available To Work?
Mon
Tue
Wed
Thu
Fri
Are You Available For Saturday Work?
Yes
No
Some times
Are You Available For Sunday Work?
Yes
No
Some times
What Time Each Day Are You Available for Work?
Present Employer
Hours You Work:
Address
Can We Call You At Work?
City
State
Present Rate
Phone
Supervisor
Job Description
Start Date
End Date
May We Contact This Employer For A Reference:
Yes
No
Your Past Employment Record:
Employer Name
Address:
Phone #:
Supervisors Name:
Pay Rate
Job Description
Start Date
End Date
Reason For Leaving
Employer Name
Address:
Phone #:
Supervisors Name:
Pay Rate
Job Description
Start Date
End Date
Reason For Leaving
Any Other Job-Related Experience You Would Like To List
REFERENCES
Name
Address
Phone #
Name
Address
Phone #
Name
Address
Phone #
Would there be any restrictions to perform the duties of the job as they have been indicated to you on the attached job requirement sheet with or without reasonable accommodation?
Yes
No
If Yes, please explain
Do you have any other questions that would help us in determining if you could perform the duties specified on the attached job requirement sheet?
Yes
No
If Yes, please inquire here
Have you ever been convicted of a crime?
Yes
No
If Yes, explain fully
Have you ever been convicted of a felony?
Yes
No
If Yes, explain fully
Have you ever been bonded?
Yes
No
If Yes, Are you presently bonded?
Yes
No
I HEREBY AUTHORIZE U.S. SERVICO, INC. OR ITS AGENTS TO PERFORM A CRIMINAL BACKGROUND CHECK AND INVESTIGATE ALL STATEMENTS CONTAINED IN THIS APPLICATION AS WELL AS EMPLOYMENT & PERSONAL HISTORY AND INCLUDING SOCIAL SECURITY VERIFICATION. I HEREBY RELEASE U.S. SERVICO, INC. OR ITS AGENTS, EMPLOYERS, SCHOOLS, OR PERSONS FROM ALL LIABILITY IN RESPONDING TO INQUIRIES IN CONNECTION WITH THIS APPLICATION AND AUTHORIZE THE RELEASE OF MY PRIOR PERSONNEL AND MEDICAL RECORDS. I UNDERSTAND THAT MISREPRESENTATION OR OMISSION OF FACTS CALLED FOR, IS CAUSE FOR DISMISSAL. I ALSO UNDERSTAND THAT ON OCCASION U.S. SERVICO CLIENTS REQUIRE PERSONNEL FILE INFORMATION FOR THEIR FILES IN ORDER TO ENTER THEIR PREMISES AND I AUTHORIZE RELEASE OF SAID INFORMATION TO THEM.
I ALSO UNDERSTAND THERE ARE NO GUARANTEES WRITTEN OR EXPRESSED BY U.S. SERVICO, INC. IF YOU ARE HIRED YOU WILL BE AN EMPLOYEE “AT WILL” AND MAY BE DISCHARGED AT ANY TIME WITH OR WITHOUT CAUSE OR WITHOUT NOTICE.
Date
How did you hear about us?
*
Web
Advertisement
Friend / Family
Referer Name
