Cleaning Job Application Form

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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 / Province

Postal / Zip CodeCountry
Day Time Phone
Format: (000) 000-0000.
E-mail
example@example.com
Referred By

First NameLast Name
Date You Are Available to To Work

MonthDayYear
Are you legally eligible to work in the U.S.?
Are you willing to take a drug test?
Do you have a valid driver's license?
How many hours do you want to work per week?
What days are you most interested in working?
What times of day are you most interested in working?
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
May we contact this employer?
(2) Employer's Name
Position Held
Supervisor's Name
Telephone
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
May we contact this employer?
Do you take any medications that can affect your ability to work?
(3) Employer's Name
Position Held
Supervisor's Name
Telephone
Format: (000) 000-0000.
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
May we contact this employer?
Reference (1) Name

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