CleanCo Job Application

Job Application

CleanCo - Levelland, TX
Application Date *

Month Day Year
Full Name *

First Name Middle Name Last Name
Phone Number *
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code 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 *
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
What Location Are you Applying For? *
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
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
End Date *

Month Day Year
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
End Date

Month Day Year
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
End Date

Month Day Year
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.
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Job Application

WORK HISTORY / EXPERIENCE

Identification

Terms and Conditions