Application

JOSEPH MAINTENANCE SERVICES - APPLICATION

Personal Information:

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Number of years at this address? *

Marital Status *

Birth Date *

Cell Phone Number *

Social Security Number *

Home Phone Number *

Email *

Do you have a VALID PA Driver's License? *

Are you able to work weekends? *

Do you currently pay child support? *

Do you have a VALID PA Commercial Driver's License (CDL)? *

Are you willing to work overtime? *

If yes (Child Support), is it garshished from your wages? *

Do you have a degree from a college, trade school or tech school that you would like to mention? Use comment box below: *

Have you completed High School? *

Do you have College, Trade School or Vo-Tech Experience or Degree? *

Current Employment Information:

Name of most recent employer: *

Address: *

Employer Phone Number: *

Do you still work for this employer? *

Dates worked for this employer: *

If you do not work for this employer currently - why not? *

Previous Employment Information:

Name of previous employer: *

Address of previous employer: *

Phone Number of previous employer: *

Reason you no longer work for this employer: *

Do you still work for this employer? *

Dates worked for this employer: *

Emergency Information:

Name of relative/acquaintance to be contacted in case of emergency: *

Relationship to you: *

Emergency Contact Cell Phone Number: *

Emergency Contact Other (Home or Work) Phone Number: *

I CERTIFY THAT THE INFOMATION ON THIS APPLICATION IS ACCURATE AND COMPLETE. GIVING INCOMPLETE OR FALSE INFORMATION IN AN APPLICATION FOR EMPLOYMENT IS A SERIOUS MATTER AND GROUNDS FOR DISMISSAL. I HERBY ACKNOWLEDGE THAT THE INFORMATION I HAVE PROVIDED TO YOU ON THIS APPLICATION IS CORRECT.

Signature (full name typed): *

Date: *

Work Reference #1:

Please provide us with PREVIOUS EMPLOYERS that we may contact for a work reference. Please note: These are WORK REFERENCES, so please list previous employers or co-workers (not a relative) that can vouch for your working ability. If you are currently employed and your boss is not aware that you are job searching, please use another reference because we MAY CONTACT THEM. Please provide two names we may contact.

Contact Name: *

Company Name: *

Job Title (owner, Shift Supervisor, Co-worker, etc.) *

Contact Phone Number: *

Company Street Address, City & Zip *

When did you work with this individual (date range)? *

Are you still employed by this company? *

May we contact them as a reference? *

Comments about your job here or the person you gave us as a contact: *

I give Joseph Maintenance Services permission to contact the above individual/company in regard to my working ability and experiences.

Please type your full name (First, Middle and Last) in the box below: *

Date *

Work Reference #2: