Initial Screening Questionnaire

Full Name *

First Name Middle Name Last Name

Date *

Today's Date

Do you have a driver's license? *

If yes, license number:

State of Issue

Expiration Date

Date

Have you had any moving violations in the last 5 years? *

Have you ever been convicted of a felony? *

Have you worked for a cleaning company in the past? *

If yes, how long did you work in the cleaning business?

If yes, tell us a little about your home cleaning experience:

List any relevant skills

Why are you considering this opportunity?

List any relevant skills

How many hours can you work in a day?

8 10

How many hours can you work in a week?

20 10

Are there any days you cannot work?

Is there anything that will restrict you from lifting 40 pounds? *

What is the best, most preferred way for us to contact you?

Phone

Email

example@example.com

Text Message

Signature

Clear

Today's Date

By clicking the submit button below, I cerity that all of the information provided by me on this questionnaire is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.

A thorough background check will be conducted prior to any employment offer.

CLCS Initial Screening Questionnaire

Sign & Submit: