For Comprehensive
Professional Cleaning
Services, Visit:
Jack's Maintenance Service

Employment Application Form

Please complete and submit this secure application form and we will contact you as soon as possible. Any personal information you provide using our secure form is kept private and safe and will be used only for purposes of employment consideration.

Fields marked with * are required in order for your application to be considered. Enter "N/A" in required fields if they do not apply to you.

We are committed to a policy of Equal Employment Opportunity/Affirmative Action and will not discriminate on any legally recognized basis, including but not limited to race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

*Position Applying For:
*Name: (Last, First, MI)
List any other names you have used (including maiden name if applicable):
*Street: *City:
*State: *Zip:
*Phone: -- Cell: --
Email:
Former Address
Street: City:
State: Zip:
Date of Birth (Optional) (MM-DD-YEAR): --
Date of Birth is being requested in order to obtain accurate retrieval of records.
Social Security Number (Optional): --
*Emergency Phone Number: --
Referred By:
Do you have a valid driver's license? Yes or No

Driver's License Number: State:

If driving is a requirement of the job for which you are applying, continued employment is contingent on your maintaining a current driver's license.
Have you ever been convicted of a felony or a crime which is related to the functions or qualifications of the position for which you are applying?
Yes or No

A conviction record will not necessarily be a bar to employment.
*Please List (2) Personal References
*Name: (Last, First)
*Street: *City:
*State: *Zip:
*Phone: -- Email:
*Name: (Last, First)
*Street: *City:
*State: *Zip:
*Phone: -- Email:
Please indicate any past experience in professional cleaning - window washing, construction cleanup, power spraying or other. List dates and places worked and equipment experience you have:
Have you ever worked at Brite-Way or Jack's Maintenance before? Yes or No
Shifts for which you are available:
Full-time Part-time
6am-2pm 2pm-12 midnight 10pm-6am
Weekends
Does heat, standing on your feet or lifting cause you any difficulties?
Yes or No

(If Yes, please explain limitations)
Please list your last (3) employers, beginning with the most recent:
*Company Name:
*Supervisor Name: (Last, First)
*Street: *City:
*State: *Zip:
*Country: *Phone: --
*Company Name:
*Supervisor Name: (Last, First)
*Street: *City:
*State: *Zip:
*Country: *Phone: --
*Company Name:
*Supervisor Name: (Last, First)
*Street: *City:
*State: *Zip:
*Country: *Phone: --
Pre-Employment Inquiry Release
In connection with my application for employment (including contract for services) with you, I understand that investigative background inquiries are to be made on myself including, criminal, and driving reports. I understand that you will be requesting information from federal, state, and county who maintain records concerning my past activities relating to my driving and criminal record.

I authorize without reservation, any party or agency contacted by Jack's Maintenance Service, Inc., or Brite-Way Services, to furnish the above information.


Note: Submission of this form constitutes a signature and the signing of this form.

   


Proudly serving the Greater Fox Valley – including Appleton, Green Bay, Kaukauna, Neenah, Menasha and Oshkosh as well as Wausau, Madison and surrounding areas in Wisconsin.


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