Great Hands For Cleaning

Great Hands For Cleaning

PROVIDER APPLICATION
Thank you for your interest in becoming a Provider with Great Hands For Cleaning. Please fill out this application with accurate and up-to-date information
Name*

First NameLast Name
Today's Date*

MonthDayYear
Date
Date Of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you legally authorized to work as an Independent Contractor in the United States?*
Do you have a valid driver's license?*
Do you have reliable transportation?*
WeekdaysWeekendsMorningAfternoonEvenings
Are you available for short-notice or last minute shifts?*
Do you own and are you able to provide your own cleaning equipment?*
Vacuum CleanerMop/BucketCleaning SolutionsCleaning RagsOther
Please upload a photo of all your cleaning equipment.*

Cancelof
How many years of professional cleaning experience do you have?*
Residential cleaningCommercial cleaningSpecialty cleaning (e.g., carpets, windows)
Please provide details of your last three cleaning jobs or contracts:
Employer/Client Name:*
MOST RECENT
Dates of Service:*
Description of Duties:*
Employer/Client Name:
Dates of Service:
Description of Duties:
Employer/Client Name:
Dates of Service:
Description of Duties:
Do you have liability insurance?*
If yes, please provide the policy number and insurance provider:
Policy Number
Insurance Provider
If No. Would you be able to obtain your own liability insurance?*
Are you willing to undergo a background check?*
Please provide at least two professional references:
Reference 1
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Reference 2
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
By signing below, you certify that all information provided in this application is true and complete to the best of your knowledge. You understand that any false or misleading information may result in your disqualification from the application process or termination of your contract if discovered after being hired.
Signature*

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Date*

MonthDayYear
Date
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