Employment

Name

First

Last

Phone

is bend employed?

What is the best method to reach you?

What is the best time to reach you?

Are you currently employed?

If applying for a specific position, where is the position located?

Are you able to be on your feet for an extended period of time?

Are you able to lift and bend as part of your job duties?

Do you have reliable transportation?

Can you perform the essential functions outlined in the job description, with or without reasonable accommodations?

How often would you say you miss a day of work due to illness, vacation, or some other reason?

Why are you looking for part-time work?

If hired and the position is a good fit, how long do you see yourself staying with this company?

What is most important to you in a part-time job?

Additional Information and Relevant Experience

Do not include any information that could be considered sensitive (SSN, Driver's License #, etc)

Jani-Clean LLC