<p>Employment Application </p><p>Dow Services is an equal opportunity employer and does not discriminate against applicants or employees on the basis of race, color, religion, sex, including pregnancy, age, mental or physical disability, genetic information, marital status, status with regard to public assistance, participation in lawful activity off the employer’s premises during nonworking hours which is not in direct conflict with the essential business-related interests of the employer, or any other characteristic protected under federal, state, or local law. In addition, Dow Services provides reasonable accommodation to individuals with disabilities as required by state and federal law. The company prohibits smoking in all company facilities and vehicles as required by state law. Smoking is prohibited in company vehicles, within twenty feet of entrances, exits, operable windows, air intakes, and ventilation systems of enclosed areas in which smoking is prohibited.</p><p>Date______</p><p>Name:______(First) (Middle) (Last)</p><p>Address______</p><p>City______State______Zip Code ______</p><p>Telephone: Home ( )______Cell ( )______Work ( )______</p><p>Best time to contact you at home: ______Can we contact you at work? Yes No </p><p>Email Address: ______</p><p>Date available for work ____/____/____ Position Applying for: Janitorial Supervisor Other______</p><p>Employment Desired: Part-time Full-time Daytime Evening/Night</p><p>If part-time, how many hours per day/night would you like? 1-2 3-4 5-7 Other______</p><p>Days of the week available:  Mon  Tues  Wed  Thurs  Fri  Sat  Sun</p><p>What time are you available to start cleaning each night:______pm Desired Wage: $______per hour </p><p>How were you referred to this position?</p><p>______</p><p>Have you ever filed an application with us before? Yes No If yes, date ______</p><p>Have you ever been employed with us before? Yes No If yes, date ______</p><p>List any acquaintances or relatives employed by this company:</p><p>______</p><p>Have you ever been convicted of a felony? Yes No If yes, explain______</p><p>A “Yes” Answer will not necessarily bar employment, however, failure to disclose a conviction will bar employment. EDUCATION:</p><p>School Name of School Course of Study Years Completed Diploma/Degree</p><p>High School</p><p>Undergrad College Graduate/Professional</p><p>Other (Specify)</p><p>WORK EXPERIENCE:</p><p>Start with your present or last job. </p><p>Dates Employed: Employer: From: To:</p><p>Hourly Rate/Salary Address: Telephone Number: Starting: Final: </p><p>Job Title: Job Duties:</p><p>May we contact: Supervisor Name & Title: Yes No </p><p>Reason for Leaving:</p><p>Dates Employed: Employer: From: To:</p><p>Hourly Rate/Salary Address: Telephone Number: Starting: Final: </p><p>Job Title: Job Duties:</p><p>May we contact: Supervisor Name & Title: Yes No </p><p>Reason for Leaving: Use the space below to write any additional comments that you feel would be important in our consideration of your application.</p><p>I certify that all information contained in this application and any attachments are true and complete to the best of my knowledge. I understand that any willful misrepresentation, false statement, or omission by me in the application or interview process will be cause for rejection of my application or termination of my employment. I authorize investigation of all statements made on this application and any attachments, and I release all persons, companies, and organizations from liability for providing or receiving such information. I further understand that this employment application and other employment related documents are not contracts of employment; and, that any oral or written statements to the contrary are hereby expressly disavowed.</p><p>Signature:______Date______</p>