Application
An Equal Opportunity Employer
It is the policy of JANEX Professional Cleaning Services to provide employment opportunities without regard to race, color,
religion, sex, national origin, age, handicap, or veteran status. IMPORTANT: Please fill in your response unless otherwise
indicated. Answers that are incomplete may prevent us from considering your application.
Present or Most Recent Employer
 Previous Employer
 Previous Employer
Company Name
 Company Name
Company Name
Telephone
 Telephone
Telephone
Salary Being/End
 Salary Being/End
Salary Being/End
Employed From/To
 Employed From/To
Employed From/To
Address, City, State, Zip
 Address, City, State, Zip
Address, City, State, Zip
Reason for Leaving
 Reason for Leaving
Reason for Leaving
Name of Supervisor
 Name of Supervisor
Name of Supervisor
Job Title
 Job Title
Job Title
Duties
 Duties
Duties
Applicant's Certification & Agreement
I Hereby Certify that my answers to the foregoing questions are true and complete and that I have not knowingly withheld any facts,
circumstances or other information which would, if disclose, affect my application. I further understand that nay false or misleading
statement or omission of pertinent information will result in the rejection of my application, or in dismissal if discovered subsequent to
my employment. I Hereby Authorize the Company to request each former employer, school attended and each person, firm or baits,
character or skill and any other data required, whether in connection with this application or for purposes of complying with surety
company requirements. I Understand that I should be given employment shall be for an indefinite period of time and be terminated, at
will, at anytime, for any reason, by me or by the company without notice or without liability whatsoever, except for unpaid wages or
salary earned by that date of termination.
Personal Information
 Position Information
First Name
 Are You Authorize to
Work in the United
States?
Middle Name
 How Soon Can You Start Working?
Last Name
 Visa Number & Expiration
 Have You Ever Been
Convicted of a Felony?
Address
 Social Security Number
If So, Please Explain
City, State, & Zip Code
Telephone Number
 Type of Employment Desire:
Date of Birth
 Full Time
 Part Time
 Temporary
Military Service and Status
References
Branch of Service
Military Occupation
 Name
 Name
Length of Active Duty
 Relationship
 Relationship
Rank at Time Separation
 Telephone
 Telephone
Please Note: Final Processing Prior To Employment Will Require A Review of the
Original or A Copy of Your Military Discharge and/or of Your DD Form 214
Name
Relatioship
Education
 Telephone
High School Name
 College?
Graduated?
Location
Dates Attended
Employment History
Note: Starting with your present or most recent employer, list in consecutive
order all employment and periods or unemployment. Additional employment
may be listed on a separate page if necessary.
I Agree
 I Disagree
Position Applying For
Graduated
Major
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