Part-Time Cleaner Application
Personal Information
Full Name
*
First Name
Last Name
Phone Number
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Employment History
Please list your 2 most recent employers
Employer Name
Employer Phone Number
Please enter a valid phone number.
Your Immediate Supervisor's Name
First Name
Last Name
Your Job Title
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Reason for Leaving
May we contact this employer?
Yes
No
Employer Name
Employer Phone Number
Please enter a valid phone number.
Your Immediate Supervisor's Name
First Name
Last Name
Your Job Title
Start Date
-
Month
-
Day
Year
Date
End Date
-
Month
-
Day
Year
Date
Reason for Leaving
May we contact this employer?
Yes
No
Availability and Work Preferences
Are you available to work Monday through Friday 8:00 am - 6:00 pm?
*
Yes
No
If not, please list your availability and explain here:
Are you legally authorized to work in the U.S.?
*
Yes
No
Do you have reliable transportation?
*
Yes
No
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References
Please list two professional references - preferably former co-workers. By listing these references, you authorize us to contact these individuals for the purpose of obtaining information related to your character and work ethic.
Name
First Name
Last Name
Relationship to You
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name
First Name
Last Name
Relationship to You
Phone Number
Please enter a valid phone number.
Email
example@example.com
Background and Legal Disclosures
If yes, please explain, and provide dates, locations, and details
Will you consent to a background check?
*
Yes
No
Equal Employment Opportunity (EEO) Statement:
Pristine Sisters Custom Cleaning is an equal opportunity employer. We do not discriminate based on race, color, religion, sex, national origin, age, disability, genetic information, or any other legally protected status in accordance with applicable federal, state, and local laws.
At-Will Employment Disclaimer
Employment with Pristine Sisters Custom Cleaning is at-will and may be terminated at any time by either party.
Certification Statement:
I certify that the information provided is true and complete. I understand that any false statements or omissions may disqualify me from employment or result in termination if hired.
Please Sign
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