Professional Facility Housekeeper

This institution does not discriminate in hiring or any other decision on the basis of race, color, sex, citizenship, national origin, ancestry, Vietnam era veteran status, or on the basis of age or physical or mental disability unrelated to ability to perform the work required. No question on this application is intended to secure information to be used for such discrimination.

• Name
• Social Security Number
• Address
• Phone
• Email
• Are you at least 18 years of age?
  • Yes
  • No
• Are you a US citizen or legally permitted to work in the US?
  • Yes
  • No
• Date Available to Start Working
• Are you currently employed?
  • Yes
  • No
• May we contact your present employer?
  • Yes
  • No

• Desired Employment Position
• Please list up to 3 in order of desire.
• Which of the following will you accept employment of?
  • Full Time
  • Part Time
  • Temporary

• Highest Level of Completed Education
• High School Name & Location
• College Name & Location
• Vocational or Business Name & Location
• Professional Education Name & Location
• Laboratory or X-Ray Training Name & Location
• Were you in the Military? If yes, which branch?
• Professional Licenses and/or Certifications
• Type Organization or State Issued Date Issued Expiration Date Number

• Previous and Current Employers
• Please list the last 3 employers you have worked for including your current employer in order from current to previous.
• Have you ever been convicted of a crime?
  • Yes
  • No
  Conviction of a criminal offense will not necessarily preclude your employment.
• If yes, please specify for what, when, and where. If no, please indicate with "N/A".
• Please indicate if you are willing to work.
  • Weekdays
  • Weekends
  • Holidays
  • Rotating Shifts
• If available, please upload your resume. Drop files here or Max. file size: 20 MB.
• Acceptance:
  • I Agree and Accept.
  I voluntarily give this institution the right to make a thorough investigation of my past employment and activities, agree to cooperate in such investigation and release from all liability or responsibility all persons, companies or corporations supplying such information. I consent to take a physical examination, and such future physical examinations as may be required by this institution at such times and places as the institution shall designate.
  
  I understand that an offer of employment may be contingent on passing the physical examination which relates to the essential duties I would be required to perform. I understand that my employment is at will, and that either party is free to terminate the employment relationship at anytime without cause. I also understand that my employment may be terminated for any misstatement or omission of fact appearing on this application form.
  
  If employed, I will be required to complete an Employment Verification Form (I-9), and within three days show satisfactory evidence of identity and eligibility for employment.