Submit Application

If you would like to apply for a job at JaniKing of Rocky Mount, fill out the form below and then press Get Printable Copy at the bottom. This form is not saved on the website. You will need to print out the form and then call 252-210-3424 to arrange a time to drop off your application. You will also need to sign and date the printed application. If you prefer, you can also download a printable copy of the application and fill it out.

JaniKing of Rocky Mount is an Equal-Oppurtunity Employer.

Your Name:
(first)
(middle)
(last)
Address:
(street)
(city)
(state)
(zip)
Phone: Mobile: Email:
Date Available to Start: // Social Security Number: --
Salary Requirements: $
If you are under 18 years of age, can you provide a work permit? Yes / No / Not Applicable
If no, please explain:
Have you ever worked for this company? Yes / No If yes, when? / (mm/yyyy)
Are you a citizen of the United States? Yes / No
If not, are you legally allowed to work in the United States? Yes / No
Type of employment desired: Full-Time / Part-Time / Temporary / Seasonal
Have you ever pleaded guilty, no contest or been convicted of a crime? Yes / No
If yes, give dates and details:
Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.
Driver's license number (if applicable to position): State:

Summerize Your Special Skills or Qualifications

Previous Employment (begin with most recent position)

Dates of Employment: From // To //
Company name: Position(s) held:
Address: City:
State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting salary and title: Ending salary and title:
Reason for leaving:
May we contact this employer for a reference? Yes / No
Dates of Employment: From // To //
Company name: Position(s) held:
Address: City:
State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting salary and title: Ending salary and title:
Reason for leaving:
May we contact this employer for a reference? Yes / No
Dates of Employment: From // To //
Company name: Position(s) held:
Address: City:
State: Zip: Phone:
Supervisor: Title:
Responsibilities:
Starting salary and title: Ending salary and title:
Reason for leaving:
May we contact this employer for a reference? Yes / No

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, educational and other related matters as may be necessary for an employment decision. I hearby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

You must sign and date the application after you have printed it. To get a printable copy of the application, click the button below.