Janitor/Grounds Skills Survey
Name: ______________________________________________ Date: _______________________
Position: __________________________________________________________________________
This information becomes part of your application. Your skills, expertise, and education will be rated based on
your answers. Please fill out this form as completely as possible. Under columns three through six, check the
category that best shows the depth of your experience. Do not check more than one column per line.
Years of relevant experience:
Check Degrees (Attach Transcripts):
Full time work
HS/GED
Part time work
Certificate
Area
Associate
Major
Bachelor
Major
Certificates & Licenses (check all that apply):
IL Driver’s License
Bondable/Bonded
IL Pesticide Applicator
IL Herbicide Applicator
Safety Driver’s Certificate
Model/
Version
Used
Years of
Training
only (1)
Preformed
with help
(2)
Performed
unaided
(3)
Instructed
others (4)
Custodial Skills:
Carpet Cleaning
Furniture Care
Laundry
Minor Repairs
Restrooms/Lavatories
Stripping Floors
Team Cleaning
Vacuuming/Sweeping
Waxing Floors
Windows
Wooden Floors Care
Other:
Continued ->
Janitor/Grounds Skills Survey
Model/
Version
Used
Years of
Training
only (1)
Preformed
with help
(2)
Performed
unaided
(3)
Instructed
others (4)
Custodial Equipment:
Buffers
Automatic Scrubbers
Extractor
High Speed Burnishers
Propane Burnishers
Strippers
Wet/Dry Vacuums
Wide Area Vacuums
Small Vacuums
High Pressure Sprayers
Other:
Custodial Specializations:
Biological Environment
Cafeteria/Kitchen
Gymnasium/Arena Facilities
Industrial/Commercial
Medical/Clinical
Residential
Child Care Facilities
Furniture Transport
Equipment Assembly
Vehicle Operation
Other:
I
have answered the above information to the best of my knowledge.
S
ignature: ______________________________________________ Date: ________________________
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signature
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