Cleaning Job Application Form

We Are Hiring Cleaners!

Apply today! 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*
example@example.com
Application Date

MonthDayYear
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

PostalCountry
Phone*
Format: (000) 000-0000.
Referred By

First NameLast Name
Date You Are Available to To Work*

MonthDayYear
0-1010-2020-3030-4040+
TuesdayWednesdayThursdayFridayEveryday (Monday - Friday)
MorningsAfternoonsFull Day
YesNo
What document can you provide as proof of citizenship or legal status?
YesNo
YesNo
If yes, please state the nature of the crime (s), when and where convicted and disposition of the case.
YesNo
If yes to the question above, please describe accommodations required below.
WORK HISTORY / EXPERIENCE

Please list your 3 most current work history/experience
Please describe your experience and what makes you a true professional cleaner.
Employer's Name (Most current)
Position Held
Supervisor's Name
Telephone
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
YesNo
(2) Employer's Name
Position Held
Supervisor's Name
Telephone
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
YesNo
(3) Employer's Name
Position Held
Supervisor's Name
Telephone
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
YesNo
References:

Please provide 1-2 references. Work, education or church related. NO FAMILY MEMBERS.
Reference (1) Name

First NameLast Name
Reference (1) Telephone
Format: (000) 000-0000.
Reference (2)

First NameLast Name
Reference (2) Telephone
Format: (000) 000-0000.
Reference (3)

First NameLast Name
Reference (3) Telephone
Format: (000) 000-0000.
AT-WILL EMPLOYMENT:
The relationship between you and Little Luxuries Cleaning LLC is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or Little Luxuries Cleaning LLC. No representative of Little Luxuries Cleaning LLC has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will", and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and with our CEO/Chief Operations Officer.
Applicant Signature: Signature and date: Date
False information will cause removal from consideration for or termination of employment.

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 the company, 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 company policies, rules, and procedures. I understand that the company 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.
Signature
Should be Empty: