Cleaning Job Application Form

We Need Green Cleaning Professionals!

All persons entered in our domestic registry must agree to use eco-friendly, non-toxic products! All information obtained in this form will be held in strict confidence, subject to applicable law. We will not discriminate because of sex, age, race, physical disability, religion, ethnicity, marital status, ancestry, or place of origin.
Application Date *

Month Day Year
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Day Time Phone *

Area Code Phone Number
E-mail *
Referred By

First Name Last Name
Date You Are Available to Start Work *

Month Day Year
Are You Legally Eligible to Work in the U.S.? *

Yes No
Are you willing to take a drug test? *

Yes No
Are you willing to forgo a background check? *

Yes No
Do you have a valid driver's license? *

YES NO
Do you have a car? *

Yes No
Do you have auto insurance? *

Yes No
Desired Salary/Wage *
How Many Hours Do You Want to Work Per Week? *

0-10 10-20 20-30 30-40 40+
What Days Are You Most Interested in Working? *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
How Long do you See Yourself Working Here? *
What Times of Day Are You Most Interested In Working? *

Mornings Afternoons Evenings
WORK HISTORY / EXPERIENCE

Please list your 3 most current work history/experience
Please Describe Your Work Experience and What Makes You a Perfect Candidate as a Professional Cleaner *
Employer's Name (Most current) *
Position Held *
Supervisor's Name *
Telephone *

Area Code Phone Number
Reason for Departure *
Duties *
Start Date *

Month Day Year
End Date *

Month Day Year
May we contact this employer? (please check one) *

YES NO
If NO, reason why not *
(2) Employer's Name *
Position Held *
Supervisor's Name *
Telephone *

Area Code Phone Number
Reason for Departure *
Duties *
Start Date *

Month Day Year
End Date *

Month Day Year
May we contact this employer? (please check one) *

YES NO
If NO, reason why not *
(3) Employer's Name
Position Held
Supervisor's Name
Telephone

Area Code Phone Number
Reason for Departure
Duties
Start Date

Month Day Year
End Date

Month Day Year
May we contact this employer? (please check one)

YES NO
If NO, reason why not
High School Name and Location *
Highest Graded Completed *
Have you attended College? *

Yes No
YOUR CLEANING PROCESS
This kitchen has not been cleaned in two weeks. Please describe in bullet points how you would clean this room. *
How wood you dust a shelf with many knicknacks on it? *

Dust the shelf and clean around the nicknacks. Remove the nicknacks, dust the shelf and line the nicknacks up. Remove the nicknacks, dust them and place them back as they were.
What is the procedure in general for cleaning any room in a house? *

Work your way in a circle cleaning everything, top to bottom, as you go. Clean up to down working your way around so not to miss anything. Clean the more difficult areas first and the easier areas last.
What would you do if there was a $20 bill laying on a table with no note? *

Take the money as a tip. Ask the client if it is meant for you. Leave it where it is. You don't know if it was meant for you.
How do you dust a picture on the wall that has no glass? *

Don't dust it. You don't want to damage it Dust only the frame. Dust the entire picture.
Please provide 3 references (work, education, etc.). NO FAMILY MEMBERS.
Reference (1) Name *
Reference (1) Telephone *

Area Code Phone Number
Reference (2) Name *
Reference (2) Telephone *

Area Code Phone Number
Reference (3) Name
Reference (3) Telephone

Area Code Phone Number
False information will cause removal from our registry.

I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if this company at anytime learns of falsification or material omission in the information provided on this application form and related documents. You may contact my former employers. All references are hereby authorized to release all information which they may have relevant to my employment with them. I hereby release Sacramento Green Clean® , its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information provided by such references. I agree that I will follow all Sacramento Green Clean® policies, rules, and procedures. I understand that Sacramento Green Clean® reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime. I agree to make myself available for random drug testing. I have never been convicted of a felony and I have no criminal charges pending against me.
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