Cleaning Technician Application

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.

Date of Birth

Date

What city do you live in?

DO YOU KNOW OR ARE YOU RELATED TO ANYONE WHO WORKS FOR ROCKING ROBINS MAIDS LLC?

How did you hear about this job?

Driving is a requirement of this job. Is your license valid?

YesNo

Do you have full time access to a vehicle? Full time use of a vehicle is required for this job.

YesNo

Is the vehicle covered by Insurance?

YesNo

Are you able at the time of employment submit verification of your legal right to work in the U. S.? *Verification and completion of 1-9 form must be submittedno later than 3 business days after hire*

YesNo

Do you have a smart phone with time? A smart phone is a requirement for this job.

YesNo

Are you able to lift 25 pounds or more?

YesNo

Do you have difficulty standing, bending, kneeling in connection with performing necessary cleaning duties?

YesNo

Are you allergic to household chemicals?

YesNo

Are you allergic to cats and/or dogs?

YesNo

Are you afraid of cats and/or dogs?

YesNo

What hours are you available to work on the following weekdays? Type in boxes

	Monday	Tuesday	Wednesday	Thursday	Friday
From
To

Are you looking for Part-Time or Full-Time work? We hire primarily full time.

If hired, when can you start work?

Date

Are you presently employed?

YesNo

Which one of the following categories have you had?

If other Explain

3 most Recent, type in boxes

	1	2	3
Name of Employer
Supervisor's Name
Phone Number
Salary
Position
Reason for leaving
Date From-To

Have you ever been convicted of a criminal offense? You must pass background to be hired

YesNo

If yes, explain

Have you ever been bonded?

YesNo

Has your driver’s license ever been suspended?

YesNo

If yes, explain.

Note* Due to the security sensitive nature of this job, The company will conduct a background check on any applicants in consideration of hiring.

Personal Reference List the names of three people not related to you, whom you have known at least three years. Include name, phone number, address and years known

Check ONLY one box (hint there is no right or wrong answer, we just want to know you better to fill your schedule)

I NEED this jobI WANT this job

Why are you interested in working for Rocking Robins Maids LLC?

Why do you think you’re a good fit for this company?

How long do you see yourself working here?

Please Read carefully.

AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION

I, the undersigned, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements will be considered as cause for possible dismissal.

I authorize Rocking Robins Maids LLC and any security agency service working for them, to disclose orally and in writing the results of this verification process and/or interview to the designated authorized representative of this company.

I have read and understand this release and consent and authorize the background verification. I authorize persons, schools, current and former employers, personal references and other organizations and Agencies to provide Rocking Robins Maids LLC with all information that may be requested, and to conduct a verification, as deemed necessary by this Company to fulfill the job requirements, with regards to my motor vehicle records, credit history as allowed by EEOC and ECOA, and to receive any criminal history record information pertaining to me which may be in the files of any Federal, State or Local criminal justice agency in Kentucky or any other States.

I hereby release all the persons and Agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy of this document is as valid as the original. All results will be proprietary and will be kept CONFIDENTIAL and disclosed orally and in writing only to the designated authorized representatives of this Company and its Clients.

I do hereby agree to forever release, discharge and indemnify Rocking Robins Maids LLC and their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting of information.

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Cleaning Technician Application

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