Employment Application Form

CleanR Employment Application

Fill the form below accurately indicating your potentials and suitability to the job you are applying for.
Name*

First NameLast Name
Birth Date

MonthDayYear
Phone Number*
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

WebsiteCleanR ClientFacebookIndeedInstagramOther (Please Specify)CleanR Employee
Name of Employee, Client, or Other Specified?
Resume and Files

Cancelof
Motivation letter (Tell us why we should consider your application)*
Do you have your own reliable vehicle for transporation?*

YesNo
Do you have a valid Drivers' License?*

YesNo
Will you be able to pass a background check and MVR (Motor Vehicle Report/Driving Record) check?*

YesNo
Do you permit CleanR to perform a background check and MVR check?*

YesNo
How many hours are you able to work each week?*

0-1010-2020-3030-40+
What days of the week can you work?*

MondayTuesdayWednesdayThursdayFridaySaturday
Are you able to work during the hours of 7:00am - 6:00pm?*

YesNoI need specific hoursOther (Please Explain)
Please explain hours and days of availability:
Work History

Please the 3 most recent employers and work history/experience.
Employer's Name (Most current)
Position held
Supervisor's Name
Phone Number
Please enter a valid phone number.
Reason for Departure
Duties performed
Start date of this employment

MonthDayYear
Date
End date of this employment

MonthDayYear
Date
May we contact this employer?

YesNo
Employer's Name
Position Held
Supervisor's Name
Phone Number
Please enter a valid phone number.
Reason for Departure
Duties Performed
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
May we contact this employer?

YesNo
Employer's Name
Position Held
Supervisor's Name
Phone Number
Please enter a valid phone number.
Reason for Departure
Duties Performed
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
May we contact this employer?

YesNo
References

Please list two (2) references that are familiar with your work life. NO FAMILY MEMBERS.
Reference
Reference
False information will be cause for removal from consideration.

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. I hereby release Houses 2 Homes® , 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 CleanR® policies, rules, and procedures. I understand that CleanR® reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime. 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.
Please verify that you are human*
Signature*

Clear
Should be Empty: