Dirtbusters Janitorial Services, Inc.

Employment Application
Note: * Denotes a required response.
Name: *
Address:
City:
State:
Zip:
Phone: *
Do you have a valid driver's license? *	Yes No
Do you have dependable transportation? *	Yes No
Are you physically able to lift 50 pounds? *	Yes No
Are you able to pass a drug test? *	Yes No
Have you ever been convicted of a crime? *	Yes No
How many hours can you work weekly? *
Are you available to work: *	Day Shift Evening Shift Night Shift
Employment Desired: *	Full-Time Part-Time Either Full or Part-Time
When are you available to start work?
Salary desired:
Are you currently employed? *	Yes No
May we contact your employer *	Yes No
Current employer contact information: