Application for Employment
Pre-Employment Questionnaire - Equal Opportunity Employer
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Date
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employment + Pay Desired
*
Full Time / Part Time + Amount of Pay Desired
Education History
High School
Name of School + # of years + Did you Graduate?
College
Name of School + # of years + Did you Graduate?
Former Employers - Most Recent First
Dates Employed
To and From
Name / Address of Employer
What did they pay you?
Position Held
Why did you leave?
What kind of reference will they give you?
Name of person still there that will give a reference for you
Dates Employed
To and From
Name / Address of Employer
What did they pay you?
Position Held
Why did you leave?
What kind of reference will they give you?
Name of person still there that will give a reference for you
Dates Employed
To and From
Name / Address of Employer
What did they pay you?
Position Held
Why did you leave?
What kind of reference will they give you?
Name of person still there that will give a reference for you
Type a question
Experience / Qualifiations
Why do you want to work for Above All Cleaning Services?
Do you have reliable transportation
Yes
No
Most of the Time
If yes, What kind of transportation to you have?
Can you provide proof of insurance?
Yes
No
What kind of driving record do you have?
What is your work availability?
Can you pass a pre-employment drug screen?
Yes
No
Maybe
Have you ever been convicted of a felony?
Yes
No
Have you ever professionally cleaned homes before?
Yes
No
If yes, where and with whom?
Were you ever a shift supervisor?
Yes
No
What did they pay you?
How long did it take you to clean those homes?
Do you think you had a good rapport with that cleaning company?
Have you ever cleaned someone else's home on the side for extra cash?
Yes
No
What did they pay you?
Did you supply the chemicals and equipment?
Yes
No
How many homes did you have?
Can you lift up to 40 lbs of gear?
Yes
No
Can you work on your hands and knees for short periods of time?
Yes
No
Can you work off a 4 foot ladder?
Yes
No
Do you like Dogs, Cats, Birds, Bunnies (pets)?
Yes
No
Can you work around them?
Yes
No
Are you sensitive to chemicals that you know of?
Yes
No
Tell me one thing that you loved about your last job.
Tell me on thing about your last boss that you liked.
Where do you see yourself in one year?
Two years?
Why do you want to clean for a paycheck?
References
Please provide 3 references - names + phone numbers
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
By signing here, you certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize the investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal, or otherwise, and release the company from all liability for any damage that may result utilization from such information. I also understand and agree that no representative of the company has the authority to enter into any agreement for employment for any specified and signed period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This wavier does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws. I understand that a consumer credit report or criminal records check may be necessary prior to my employment. If such reports are required, I understand that, in compliance with federal law, the company will provide me with notice. I also understand that a poor credit history or conviction will not automatically result in disqualification from employment.” In compliance with the federal all, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
Please sign here:
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