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
Location*
Choose Your City
Referred By
First & Last Name
Position*
Full Name*

First NameMiddle NameLast Name
D.O.B*

MonthDayYear
Social Security Number*
###-###-####
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*
E-mail Address*
Emergency Contact *
Name & Phone Number
Date You Are Available To Work*

MonthDayYear
Date
Have You Ever Been Convicted Of A Felony? (Convictions will not necessarily disqualify an applicant for employment.)*

YesNo
If Yes, Explain If Not Put N/A: *
Are You Legally Eligible To Work In The U.S.?*

YesNo
Do You Have A Valid Driver's License?*

YESNO
How Many Hours Do You Want To Work Per Week?*

0-1010-2020-30
What Times of Day Are You Most Interested In Working?*

MorningsAfternoonsEvenings
What Days Are You Available To Work?

MondayTuesdayWednesdayThursdayFriday
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?*
What Do You Prefer To Clean?*
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?*

YesNo
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*
Reason for Departure*
Duties*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
May we contact this employer? (please check one)*

YESNO
If NO, explain why not*
(2) Employer's Name*
Position Held*
Supervisor's Name*
Telephone Number*
Reason for Departure*
Duties*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
May we contact this employer? (please check one)*

YESNO
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*
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