Job Application
CleanCo - Levelland, TX
Application Date
*
-
Month
-
Day
Year
Date Picker Icon
Full Name
*
First Name
Middle Name
Last Name
Phone Number
*
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
E-mail
*
Birthday
*
-
Month
-
Day
Year
Date
Driver's License Number
*
Social Security Number
*
Are You a (See Form I-9):
*
Citizen of the United States
A Noncitizen National of the United States
A Lawful Permanent Resident
An Alien Authorized to Work
Marital Status
*
Single
Married
Separated
Divorced
Widowed
Emergency Contact
*
First Name
Last Name
Relationship to Emergency Contact
*
Emergency Contact's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact's Phone Number
*
Referred By (If Applicable)
First Name
Last Name
Date You Are Available to To Work
*
-
Month
-
Day
Year
Date Picker Icon
What Location Are you Applying For?
*
Brownfield, TX
Denver City, TX
Fort Stockton, TX
Kermit, TX
Lamesa, TX
Levelland, TX
Littlefield, TX
Lubbock, TX
Monahans, TX
Odessa, TX
Plainview, TX
Seminole, TX
Tahoka, TX
What Days Are You Available to Work (Select All That Apply)?
*
Sundays
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
What Time Of Day Are You Available To Work?
*
Day Time (8 a.m. - 5 p.m.)
Evening (5 p.m. - 12 a.m.)
Anytime
T-Shirt Size
Small
Medium
Large
XL
2XL
3XL
4XL
5XL
Do You Currently Work At Another Job?
*
Yes
No
If YES, Where?
Company Name
If YES, Current Employer's Phone Number
-
Area Code
Phone Number
WORK HISTORY / EXPERIENCE
Employer's Name (Most Current)
*
Position Held
*
Supervisor's Name
*
Telephone
*
Reason for Departure
*
Duties
*
Start Date
*
-
Month
-
Day
Year
Date Picker Icon
End Date
*
-
Month
-
Day
Year
Date Picker Icon
May we contact this employer? (please check one)
*
YES
NO
If NO, reason why not
(2) Employer's Name
Position Held
Supervisor's Name
Telephone
Reason for Departure
Duties
Start Date
-
Month
-
Day
Year
Date Picker Icon
End Date
-
Month
-
Day
Year
Date Picker Icon
May we contact this employer? (please check one)
YES
NO
If NO, reason why not
(3) Employer's Name
Position Held
Supervisor's Name
Telephone
Reason for Departure
Duties
Start Date
-
Month
-
Day
Year
Date Picker Icon
End Date
-
Month
-
Day
Year
Date Picker Icon
May we contact this employer? (please check one)
YES
NO
If NO, reason why not
Identification
Please upload a copy of your Social Security Card and Driver's License. These images can be obtained by taking a picture with your phone's camera or by scanning the documents to your computer. Once obtained, attach the pictures to the application by selecting 'Select Image' and then selecting each file from the location the images were saved.
Upload Copy of Social Security Card
Upload Copy of Driver's License
Terms and Conditions
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 CleanCo, 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 CleanCo policies, rules, and procedures. I understand that CleanCo reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime.
Submit
Should be Empty: