Last Name :
First Name:
Street Address :
Apt. No.:
City:
State:
Zipcode:
Main Phone:
Email:
No
yes
Do you have a good work history? Yes No
We perform drug screenings and back ground checks, would that be a problem? Yes No
Our policy is that the prospective employee pays for the drug screening and is reimbursed when clean results are returned, would that be a problem? Yes No
Do you have a reliable form of transportation and phone? Yes No
Do you work well with others? Yes No
Our hours vary at times, is that a problem? Yes No
Are you afraid of heights? Yes No
Can you carry a 28’ ladder alone? Yes No