Personal Information

 Name:       Phone:  

  Street Address:  

  City:        State:        Zip:   

  Social Security #:       Drivers License:  

  DUIs, accidents or traffic tickets in the past three years?  Yes    No

  Are you at least 18 years of age?   Yes    No

Work Experience

  Were you previously employed by Pride Master, Inc.?   Yes    No

  If yes; please give reason for separation 

  Are you an experienced window cleaner?   Yes    No

  If yes; provide information for the last company you worked for.

       Company:      Phone #:  

       Years employed:      Pay Rate:  

       Reason for separation:  

  Check all boxes that apply with regard to your experience:

             Store Front      Single Story Offices     Residential

             Low Rise Office Buildings     High Rise Office Buildings

             Institutions or Hospitals     Factory / Plant / Machine Shop

  Indicate amount of experience with each of the following:

             Ground Level / Reachable:  0 - 6 months    6 - 12 months

                                                    1 - 2 years    more than 2 years

             Extension Pole:   0 - 6 months   6 - 12 months   

                                                  1 - 2 years     more than 2 years

             Sectional Ladders:    0 - 6 months    6 - 12 months

                                             1 - 2 years    more than 2 years

             Chair Work (RDS):    0 - 6 months    6 - 12 months

                                               1 - 2 years    more than 2 years

  Please detail any other pertinent experience below.

  If not an experienced window cleaner state other applicable experience:

Other Data

  Areas indicated in Red are voluntary data.  All others are required.

  Describe medical conditions which may limit your abilities:

  Do you take any prescribed drugs or medications?   Yes    No

  If yes, explain:  

  Ever received workers compensation for injury at work?  Yes   No

  Have you ever been convicted of a felony?   Yes   No

  Have you ever been treated for drug or alcohol addiction?  Yes  No

  Will you submit to a polygraph if one is ever needed?   Yes   No

  Age:       Height:        Weight:   

                               Applicants must acknowledge the following

     In order to have your application accepted as valid; you must type your name in the signature box below. All applicants should be aware that typing your name in the signature box will constitute your signature. By typing your name in the signature box below you certify that all information provided in the application is true and correct and acknowledge that falsification of information on the application will be considered just cause for termination. Your signature below is also considered to be your acknowledgement that Pride Master, Inc. does not condone any employee taking drugs, drinking alcoholic beverages nor being under the influence of either of the two during work hours and that we, Pride Master, Inc. reserve the right to test any employee for such use or abuse, at any time, without prior warning.

  Applicant Signature:    Date: