Job Application: Floor/Carpet Care Specialist

Fields marked with an asterisk (*) must be filled out before submitting.

First Name: *
Middle Name:
Last Name: *
Street Address: *
City, State, Zip Code: *
Telephone: *
Are you eligible to work in the United States? *	Yes No
If you are under age 18, do you have an employment/age certificates? *	Yes No N/A
If hired, would you have transportation to/from work assignments? *	Yes No
Have you had any moving violations during the past three years? *	Yes No
If yes, how many?
Please describe:

Position applying for: *
Indicate availability to work: *	Full time Regular Part-time Temporary (such as summer or holidays)
Can you work weekends? *	Yes No
What days and hours are you available to work? *
What date are you available to start work? *
REFERRAL SOURCE (if applicable):

Name and Address of School(s) attended – Degree/Diploma obtained: *
List Relevant Skills and Qualifications: Licenses, Skills, Training, Awards obtained: *

Present or Last Position:
Employer: *
Address: *
May We Contact Your Present Employer: *	Yes No
Supervisor: *
Position Title: *
Responsibilities: *
Dates Employed: *
Salary: *
Phone: *
Email:
Reason for Leaving:
Previous Position 1:
Employer: *
Address: *
Supervisor: *
Phone: *
Email:
Position Title: *
Responsibilities: *
Dates Employed: *
Salary: *
Reason for Leaving:
Previous Position 2:
Employer:
Address:
Supervisor:
Phone:
Position Title:
Responsibilities:
Dates Employed:
Salary:
Reason for Leaving:
Previous Position 3:
Employer:
Address:
Supervisor:
Phone:
Position Title:
Responsibilities:
Dates Employed:
Salary:
Reason for Leaving:

Name/Title, Address, Phone *

Resume/CV
Cover Letter

	* I HEREBY CERTIFY THAT ALL OF THE INFORMATION PROVIDED BY ME IN THIS APPLICATION (OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTS) IS CORRECT, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT THE FALSIFICATION, MISREPRESENTATION OR OMISSION OF ANY FACTS IN SAID DOCUMENTS WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT REGARDLESS OF TIMING OR CIRCUMSTANCES OF DISCOVERY. BY ELECTRONICALLY SIGNING BELOW, I GIVE MY PERMISSION FOR PRIOR EMPLOYERS TO DISCLOSE INFORMATION ABOUT ME TO LOSO PROFESSIONAL JANITORIAL SERVCES, INC. I AUTHORIZE LOSO PROFESSIONAL JANITORIAL SERVICES, INC. TO EXAMINE MY BACKGROUND AS DESCRIBED IN THIS APPLICATION, INCLUDING BUT NOT LIMITED TO ALL MY PRIOR WORK HISTORY, EDUCATIONAL BACKGROUND, CRIMINAL RECORDS CHECK, AND DRIVING RECORD, WHETHER OR NOT LISTED HERE. I WAIVE ANY AND ALL RIGHTS TO SUE ANY PERSON WHO PROVIDES INFORMATION TO LOSO PROFESSIONAL JANITORIAL SERVICES, INC. AS A RESULT OF THE REFERENCE REQUEST AND THE RIGHT TO SUE LOSO PROFESSIONAL JANITORIAL SERVICES INC. FOR MAKING THE REQUEST AND/OR USING THE INFORMATION OBTAINED IN CONSIDERATION OF MY APPLICATION FOR EMPLOYMENT AND CONTINUED EMPLOYMENT.
Loso’s Professional Janitorial Services, Inc. may keep this application on file and/or discard it in its sole discretion at any time.
ACCEPTED AND AGREED:
Signature *
Date *

	* I have been informed of the requirements of the position for which I have applied and interviewed for at Loso’s Professional Janitorial Services, Inc. I have the physical ability to perform the tasks required of me in this position and have no physical condition at the present time nor any pre-existing conditions that would prohibit me from performing the functions of the job as explained to me. By my electrical signature, I am stating that I am in good physical condition and have no knowledge of any pre-existing condition that would prohibit me from performing the required job tasks. By my electrical signature, I hereby waive any claims from any and all injuries or other such liabilities that may arise from my failure in being forthcoming to stating any pre-existing conditions which would cause me to fail to perform the job functions of this position.
Signature of Applicant: *
Date: *
Thank you for your interest in working at Loso’s Professional Janitorial Services, Inc.