2008 Ethics Award Winner

Midnight
Janitorial Inc.

Angella Luyk
(585) 230-4008
FAX (585) 342-5609
Angella@midnightjanitorial.com

"We don't cut corners,
we clean them"

Midnight Janitorial of Rochester, NY is an equal opportunity employer, always seeking high energy good people to learn a new skill.

*Indicates required field.

*Position for which you are applying:

How did you learn of this opening?

*Date you could start:
Format: MM/DD/YYYY

*Rate desired:
$

NAME

*Last:

*First:

Middle Int.:

ADDRESS

*Street:

*City:

*State:

*Zip Code:

CONTACT INFORMATION

*Main Phone: xxx-xxx-xxxx	Cell Phone: xxx-xxx-xxxx	Work Phone: xxx-xxx-xxxx	Pager: xxx-xxx-xxxx

*Email Address:

Are you over 21? Yes No

• For the purpose of compliance with the United States Immigration and Nationalization Act

are you legally eligible for employment in the United States? Yes No

• Were you previously employed by Midnight Janitorial, Inc.? Yes No

If so, please provide employment dates, position title and department:

• Have you ever been convicted of a felony or misdemeanor, other than minor traffic violations?

Yes No (If yes, explain )

• Do you have a valid driver's license? Yes No

License Number :

License State:

License Expiration Date:

• Have you ever been fired or resigned from a position after being notified you would be fired?

Yes

If yes, explain

• Please select the boxes that correspond to the evenings that you are available to work.

M T W Th F Sa Su

• Can you read and understand instructions written in English? Yes No

• Do you have dependable transportation of your own? Yes No

(Bus transportation does not qualify)

• Are you related to anyone employed by Midnight Janitorial, Inc.? Yes No

If yes, who?

• Do you have prior cleaning experience? Yes No

If yes, details:

References: Please give the names of 3 persons NOT related to you, whom you have

known at least one year:

1.	Name:	Years known:
	Tel #:	Occupation:

2.	Name:	Years known:
	Tel #:	Occupation:

3.	Name:	Years known:
	Tel #:	Occupation:

Present Employer:
Address:
Name of Supervisor:	Tel#:

May we contact this employer? Yes No

Emergency contact persons

Name:

Relationship to you:

Tel#:

Name:

Relationship to you:

Tel#:

	Name & Location	Date		Degree	Date Graduated	Area of Study / Additional Notes
	Name & Location	From	To	Degree	Date Graduated	Area of Study / Additional Notes
High School or Highest Grade Completed
College or University
College or University
College or University
Business or Trade School

• If you expect to complete an educational program in the near future, please indicate what

type of degree and when you expect to receive it:

Employment History, beginning with the most recent. Include any related military service or volunteer work.

	Name of Employer	Address/Telephone#	Position held	Dates of employment	Supervisor
1.
2.
3.
4.
5.

I certify that the statements in this application are true and complete to the best of my knowledge, and I agree that any intentional misstatement or omission will constitute grounds for unfavorable consideration of my application or dismissal from employment with Midnight Janitorial, Inc.

I authorize Midnight Janitorial, Inc. to obtain information from past employers and other sources to support the data on this application, including a review of my educational, criminal and credit records, as appropriate.

You may contact my PRESENT employer Yes No

If no, explain:

I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated at any time without any previous notice.

*Date: Format: MM/DD/YYYY

Midnight Janitorial Inc.

"We don't cut corners, we clean them"

Midnight
Janitorial Inc.

"We don't cut corners,
we clean them"