Cleaning Job Application Form

We Need Cleaning and Maintenance Professionals!

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.
E-mail*
Application Date*

MonthDayYear
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth

MonthDayYear
Date
Day Time Phone*

Area CodePhone Number
E-mail*
Referred By

First NameLast Name
Date You Are Available to To Work*

MonthDayYear
Are You Legally Eligible to Work in the U.S.? *

YesNo
Are you willing to take a drug test? *

YesNo
Do you have a valid driver's license?*

YESNO
Do you have a reliable transportation?*

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

0-1010-2020-3030-4040+
What Days Are You Most Interested in Working? *

WeekdaysWeekends
What Times of Day Are You Most Interested In Working?*

MorningsAfternoonsEvenings
What days are you available to work?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
WORK HISTORY / EXPERIENCE

Please list your 2 most current work history/experience
Please Describe Your Cleaning Experience and What Makes You a True Professional Cleaner*
Employer's Name (Most current)*
Position Held*
Supervisor's Name*
Telephone*

Area CodePhone Number
Reason for Departure*
Duties*
Start Date*

MonthDayYear
End Date*

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

YESNO
If NO, reason why not
(2) Employer's Name
Position Held
Supervisor's Name
Telephone

Area CodePhone Number
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

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

YESNO
If NO, reason why not
We DO NOT consider OR interview anyone who cannot provide2 references (work, education or church related). NO FAMILY MEMBERS.
Reference (1) Name*
Reference (1) Telephone*

Area CodePhone Number
Reference (2) Name*
Reference (2) Telephone*

Area CodePhone Number
False information will cause removal from our registry.

I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if this company at anytime 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 hereby authorized to release all information which they may have relevant to my employment with them.
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We Need Cleaning and Maintenance Professionals!

WORK HISTORY / EXPERIENCE

We DO NOT consider OR interview anyone who cannot provide2 references (work, education or church related). NO FAMILY MEMBERS.

False information will cause removal from our registry.