Upkeep Maintenance Services
Application For Employment
We consider applicants for all positions without regard to race, religion, sex, age, or any other legally protected status.
Date of Application: *
Referral Source:
Advertisement
Employment Agency
Friend
Relative
Walk-In
Other
Name: *
Last
First
Middle
Email Address:
Street Address: *
City: *
Zip/Postal Code: *
Phone (With Area Code)
Social Security Number: *
Has your license ever been suspended or revoked? *
No.
If Yes, please explain
Do you have a current valid driver's license with proof of insurance?
Yes
No
Have you filed an application here before?
Yes
No
If Yes, give date
Have you ever been employed here before?
Yes
No
If Yes, give date
Are you employed now?
May we contact your current employer?
Yes
No
Yes
No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.)
Yes
No
On what date would you be available for work? *
Are you available to work
Full Time
Part Time
Shift Work
Temporary
Are you on a lay-off and subject to recall?
Yes
No
Have you been convicted of a felony? (Conviction will not necessarily disqualify applicant from employment.)
Yes
No
If Yes, please explain
AN EQUAL OPPORTUNITY EMPLOYER
Employment Experience
1) Employer
Address
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
2) Employer
Address
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
3) Employer
Address
Job Title
Supervisor
Work Performed
Dates Employed
From
To
Hourly Rate/Salary
Starting
Final
Reason for Leaving
Please list any special skills or qualifications you have that would be useful for this type of work.