Join Our Team Application for Jolley Services Inc. Name First Name Last Name Email * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Driver License Number and State Issued Person to Contact in Case of Emergency Please enter their full name and phone number. Do you know or are you related to anyone who works for Jolley Services? Driving is a requirement of the job. Is your license valid? Yes No Do you have full time access to a vehicle? Yes No Is the vehicle covered by liability insurance? Yes No Insurance Company and Policy Number Make of Vehicle, Model, and Year Are you able, at the time of employment, to submit verification of your legal right to work in the United States? Verification and completion of the I-9 form must be submitted no later than 3 business days after hire. Yes No Are you able to lift 25 pounds or more? Yes No Would you have difficulty standing, bending, or kneeling in connection with performing necessary cleaning duties? Yes No Are you allergic to household chemicals? Yes No Are you allergic to cats and/or dogs? Yes No Are you afraid of cats and/or dogs? Yes No What hours are you available to work? Please enter times for each day you are available. Are you presently employed? Yes No If you are presently employed, may we contact your present employer? Which of the following categories of jobs have you had? Please select all that apply. House Cleaning Fast Food Homemaker Hotel/Motel Janitorial Manufacturing Restaurant Sales Service Work Experience List below your last three employers, starting with your present or last place of employment. Employment 1 Date (mo/year) Name and Address of Employer Salary and Position Supervisor's Name and Phone Number Reason for Leaving Employment 2 Date (mo/year) Name and Address of Employer Salary and Position Supervisor's Name and Phone Number Reason for Leaving Employment 3 Date (mo/year) Name and Address of Employer Salary and Position Supervisor's Name and Phone Number Reason for Leaving Educational Background High School Name and Location College Name, Location, and Area of Study Trade, Business, or Graduate School Information Have you ever been convicted of a criminal offense? Yes No If yes, please explain: Have you ever been bonded? Yes No Has your driver's license ever been suspended? Yes No If yes, please explain: Note: Due to the security-sensitive nature of the job, all employees are required to be bonded. As a matter of policy, the company conducts a police background and driving record check on any applicant in consideration of hiring. Personal References List the names of three persons not related to you, whom you have known for at least three years. Reference One Name, Address, Occupation, Phone, Years Known Reference Two Name, Address, Occupation, Phone, Years Known Reference Three Name, Address, Occupation, Phone, Years Known Check ONLY one box There is no right or wrong answer, we just want to know you better in order to fill your schedule I NEED this job I WANT this job Why are you interested in working for Jolley Services? Why do you think you are a good for this company? How long do you see yourself working here? Can you go without smoking for 4 hours? Yes No Consent to Random Drug Testing * Jolley Services Inc. is committed to maintaining a safe and productive work environment. As part of this commitment, we conduct random drug testing for all employees. By signing below, I acknowledge and consent to the following: I understand that, as a condition of employment, I may be required to participate in random drug testing. I hereby give my consent to such testing and agree to comply with the company's drug testing policy. I understand that refusal to participate in testing, or a positive test result, may result in disciplinary action, including termination of employment. I consent to random drug testing I do NOT consent to random drug testing Thank you for your application!
