Application

An Equal Opportunity Employer

Equal access to programs, services and employment is available to all persons. Those applicants requiring reasonable accommodation to the application and / or interview process should notify a representative of the Human Resources Department.

Online Application

Position(s) Applying for

Date of Application(Required)

Date Available for Work(Required)

Name(Required)

First Middle Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Mobile/ Beeper/Other Phone Number

Email(Required)

Emergency Contact

Name(Required)

Relationship(Required)

Phone(Required)

If you are under the age of 18, and it is required, can you furnish a work permit?(Required)

I am certifying that I am able to perform the essential function of the job, for which I applying, with or without reasonable accommodation, as described to me during the application process and through any printed material made available to me.(Required)

Have you ever been employed here before? If yes, give dates and positions.

Are you legally eligible for employment in this country?

Type of employment desired.(Required)

Are you able to meet the attendance requirements of the position(Required)

Have you ever plead “guilty” or “no contest” to, or been convicted of a crime?(Required)

If yes, please provide date(s) and details.

ANSWERING YES TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT, FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.

Employment History

Provide the following information of your past two (2) employers, starting with the most recent.

1. Start Date(Required)

1. End Date(Required)

1. Employer(Required)

1. Phone(Required)

1. Starting Salary and Job Title(Required)

1. Address(Required)

Street Address City / State ZIP / Postal Code

1. Immediate Supervisor(Required)

1. Summarize the nature of the work performed and job responsibilities.(Required)

1. Reason for Leaving(Required)

2. Start Date(Required)

2. End Date(Required)

2. Employer(Required)

2. Phone(Required)

2. Starting Salary and Job Title(Required)

2. Address(Required)

Street Address City / State ZIP / Postal Code

2. Immediate Supervisor(Required)

2. Summarize the nature of the work performed and job responsibilities.(Required)

2. Reason for Leaving(Required)

Skills and Qualifications

Summarize any training, skills, license and/or certifications that may qualify you as being able to perform job-related functions in the position for which you are applying.

Education Background (if job related).

Name & Location

High School College Other

Number of Years Completed

High School College Other

Did you Graduate?

High School College Other

Business References

Reference 1(Required)

Name Phone Number of Years Known

Reference 2(Required)

Name Phone Number of Years Known

Reference 3(Required)

Name Phone Number of Years Known

Applicant Statement

I certify that all information I have provided in order to apply for and secure work with the employer is true, complete and correct. I understand that consideration for employment is conditioned upon the results of a reference check, and that Circle A Janitorial Services, LLC is authorized to investigate all statements by the applicant upon the application and to contact former employers and references. I understand that a drug test may be required after an offer of employment has been made as a condition of employment. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient to cause (1) cancel further consideration of this application or (2) immediate discharge from the employer service, whenever it is discovered. I understand that this application will remain current for only 60 days. I understand that I am an “at will” employee, that either I or the employer can terminate my employment for any reason, with or without notice or cause. I also understand that if I am hired, I will be required to provide proof of identity and legal authorization to work in the United States and that federal immigration laws require me to complete an I-9 Form. I understand that if hired, I will become an employee of Circle A Janitorial Services, LLC and additional information is contained in your employee handbook. Circle A Janitorial Services, LLC’s physical address is 8229 Valencia Avenue, Unit G, Lubbock, TX 79424, and mailing address is 5815 82nd Street, Ste. 145, Box 122, Lubbock, TX 79424. Circle A can be reached by telephone at 1-806-797-6977, or fax at 1-806-797-3437. This agreement supersedes any and all agreements, written or oral regarding your employment. Your employment will be governed by the laws of Texas.

DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENTS.

I CERTIFY THAT I HAVE READ, FULLY UNDERSTAND AND ACCEPT ALL OF THE FOREGOING APPLICANT STATEMENTS.

Signature of Applicant(Required)

Date(Required)