Cleaning Innovations Application

Do you Love to Clean? We want you on our team!

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.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Referred By
First & Last Name
Full Name

First NameMiddle NameLast Name
D.O.B

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Social Security Number
###-###-####
Driver License Number
###-###-####
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number
Format: (000) 000-0000.
E-mail Address
Emergency Contact
Name & Phone Number
Date You Are Available To Work

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Have You Ever Been Convicted Of A Felony? (Convictions will not necessarily disqualify an applicant for employment.)
If Yes, Explain If Not Put N/A:
Are You Legally Eligible To Work In The U.S.?
Do You Have A Valid Driver's License?
How Many Hours Do You Want To Work Per Week?
What Times of Day Are You Most Interested In Working?
What Days Are You Available To Work?
What Time Can You Start Work On The Days You Selected?
Cleaning Experience and Quality Questionnaire

All Questions Must Be Answered
Do You Have Cleaning Experience?
If Yes, How Many Years. If Not Put N/A:
Do You Have Reliable Transportation?
Are You Able To Bend and Stand For Long Periods Of Time?
Do You Work Well With Others?
Explain How You Handle, Corrective Criticism:
Are You A Person Who Pays Extra Attention To Details?
If Hired Explain How You Will Ensure That We Maintain Our High-Quality Cleaning Services By Pay Extra Attention To Details?
WORK HISTORY / EXPERIENCE

Please list your most current work history/experience
Employer's Name (Most current)
Position Held
Supervisor's Name
Telephone Number
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
May we contact this employer? (please check one)
If NO, explain why not
(2) Employer's Name
Position Held
Supervisor's Name
Telephone Number
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
End Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
May we contact this employer? (please check one)
If NO, explain why not
False information will cause removal from our registry.

I, at this moment, state that all information provided is accurate and may be verified by you. I agree that I may be discharged if this company at any time 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 now authorized to release all information they may have relevant to my employment. I now release Cleaning Innovations, 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 Cleaning Innovations policies, rules, and procedures. I understand that Cleaning Innovations reserves the right to add, change, or delete any policies, procedures, work rules, or benefits at any time. 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.
Type Signature
Should be Empty: