Job Application (English)

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 Graduation Year:
Highest Graded Completed
Have you attended College?

Yes No
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
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Signature *
Enter the message as it's shown *
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We Need Green Cleaning Professionals!

WORK HISTORY / EXPERIENCE

Please provide 3 references (work, education, etc.). NO FAMILY MEMBERS.