Personal Information


    Previous Address

    Are you interested in:*

    Minimum Acceptable Salary

    Date Available*

    How were you referred to JaniTek?*

    Are you able to perform the essential functions of the job for which you are applying with or without reasonable accommodation?*


    High School*



    Employment History

    List employment starting with your most current position

    Employer 1

    Employer 2

    Employer 3

    Additional Information


    Identify and employment eligibility of all new hires will be verified as required by the Immigration Reform and Control Act of 1986. All offers of employment are contingent on the presentation of proof of the legal right to work in the U.S. Any uncertainty in answering the questions below should be resolved in favor of disclosure. This information will not necessarily bar an applicant from employment. The nature and seriousness of the crime, the date of conviction, and the relation to the position sought will be considered. Applicants need not disclose information pertaining to sealed, expunged, pardoned, or statutorily eradicated arrest or conviction records.

    Have you ever been convicted of a felony?

    Have you ever been convicted of a misdemeanor?


    CA applicants: Exclude information regarding (1) Any arrest or detention that did not result in conviction; (2) convictions of marijuana offenses in violation of CA Health and Safety Code Sections 11357(b) or (c) or a statutory predecessor thereof, 11360(c) [now (b)], 11364, 11365, or 11550, as they related to marijuana prior to January 1, 1976 or a statutory predecessor thereof, which are more than 2 years old; (2) any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed pursuant to CA Penal Code Section 1203.4 and (3) any arrest for which a pretrial diversion program has been successfully completed. CT applicants: Do no disclose arrests, criminal charges, or convictions for which records have been erased pursuant to Conn. Gen. Stat. 46b-146, 54-176, or 54-142. These records pertain to findings of delinquency; findings that a child was a member of a family with service needs; adjudications as a youthful offender; dismissed or nolled criminal charges; criminal charges for which you have been found not guilty; or convictions for which you received absolute pardons. Applicants whose criminal records have been so erased are deemed never to have been arrested and may so swear. HI applicants: Do not answer either of the above 2 questions. MA applicants: Include all misdemeanor convictions and completed periods of incarceration within the last 5 years if any of the convictions or completed periods of incarceration occurred within in the last 5 years. Include all convictions for felonies. Exclude first convictions for any of the following: drunkenness, simple assault, speeding, minor traffic violations, affrays or disturbing the peace. An applicant for employment with a sealed record on file with the Commissioner of Probation may answer “no record” with respect to any inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment may answer “no record” with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the Superior Court for criminal prosecution. NV applicants: Include all felony convictions. Only include misdemeanor convictions within the last 7 years which resulted in imprisonment. WA applicants: Only include convictions or imprisonments within the last 10 years for any crime reasonably related to the type of work you are seeking.

    Please read carefully

    JaniTek considers applicants for all positions without regard to race, color, religion, sex, national origin, disability, age, veteran status or any other characteristic protected by applicable law. Further no information obtained by JaniTek in response to any question in this application will be used in violation of any federal, state or local law. In submitting this application for employment, I understand that an investigation may be made whereby information is obtained regarding my character, previous employment, general reputation, educational background, credit record, driving record and/or criminal history. I authorize anyone possessing this information to furnish it to JaniTek and/or a third party company upon request and I release anyone so authorized, JaniTek and any third party company from all liability and damages whatsoever in furnishing, obtaining or using said information. For CA applicants: Should a search of public records, including record documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment, be conducted by internal personnel employed by the Company, you are entitled to copies of any such public records obtained by the company if you check mark the box below. If you are not hired as a result of such information, you are entitled to a copy of any such records even if you have not checked the box below. I elect to receive a copy of any public record described in paragraph above. If I am employed by JaniTek, I understand that false or misleading information given in my application or interview may result in immediate dismissal. I understand also, that I am required to abide by all rules, regulations, policies, and procedures of JaniTek. JaniTek requires that any applicant whom a contingent offer of employment is made must pass a drug test consistent with applicable laws and regulations. An offer of employment is contingent upon an applicant’s submission to passing the drug test. By signing this Employment Application, I agree to undergo drug testing by urinalysis. I understand the results of this test will be disclosed to Janitek, or anyone else on a need to know basis or as required by law. I understand that if I refuse to consent to testing, fail to provide a urine sample when requested, provide a false or tampered urine sample, or the drug test result is positive, I will not be hired by JaniTek in accordance with the drug testing policy. I understand and agree that if I am employed, the employment will be “at will” That is either JaniTek or I may end the employment and that this application and/or any other JaniTek documents are not contracts or employment. I certify that the information contained in this application for employment is correct to the best of my knowledge and I understand that misrepresentation of the facts given in this application may be grounds for refusal to hire or grounds for termination of employment. This application is void after 60 days unless renewed.