I agree to any Background Checks, Consumer Reports, and/or Drug Testing, and agree to all the terms and conditions laid out in the Authorization For Consumer Reports: YesNo
List all addresses during the past 7 years
Full TimePart TimeDaytimeEvening
Office CleaningFloor MaintenanceCarpet MaintenanceLead PersonSupervisor
Commercial Office CleaningFloor Maintenance of Commercial TilingCarpet MaintenanceSupervisory Work
Date Available (eg. ##/##/####)
Hours Available / Wk.
Will you work Overtime? YesNo
Are there any restrictions on the amount of weight you can lift? YesNo
If yes, how many lbs?
Do you have any impairments, physical or mental, that would substantially limit your ability to perform the job for which you are applying? YesNo
Do you have friends or relatives working here? YesNo
Do you have your own transportation? YesNo
Do you have a valid Driver’s License? YesNo
Do you speak fluent English? YesNo
Are you authorized to work in the United States? YesNo
Are you currently employed? YesNo
Do you plan on continuing employment if hired? YesNo
Please list 3 references whom are not related to you.
I am currently employed here YesNo
First Day of Employment (eg. ##/##/####) Final Day of Employment (eg. ##/##/####)
I hereby certify that the information contained in this application is true and correct, and I authorize the representatives from Rock Valley Industries, LLC to contact any of my employers, current or former, and other references, unless otherwise stated, for the purpose of collecting information regarding my employment with them.
I understand that if I am employed by Rock Valley Industries, LLC, any misrepresentation of the facts as stated on this application form is sufficient cause for dismissal. I also understand that by completing this application, Rock Valley Industries, LLC is not bout in any way to hire me.