Premier Cleaning Services Job Application

1451 W. 5175 S. #103, Riverdale, UT 84405, 801-393-5767

We are seeking responsible and mature cleaning professionals with good communication skills and the who take pride in their work. 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.
Application Date*

MonthDayYear
Job Ad You Are Applying To
(Ogden Evening, Layton Day, Floater Evening, Floater Day, Carpet Cleaner, etc.)
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail
Referred By

First NameLast Name
Date You Are Available to To Work*

MonthDayYear
Less than one yearLong-term
If less than one year, please explain:
Expected Hourly Wage $*
YesNo
YESNO
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
MorningsAfternoonsEveningsLate Night
0-1010-2020-3030-4040+
YesNo
What means of transportation do you have?*
YesNo
If Yes, explain in detail:
YesNo
If Yes, explain:
YesNo
YesNo
YesNo
WORK HISTORY / EXPERIENCE

Please list your 3 most current work history/experience
Please Describe Your Cleaning Experience and What Qualifies You to be Hired as a Cleaner*
Employer's Name (Most current)*
Position Held*
Supervisor's Name*
Telephone*

Area CodePhone Number
Reason for Departure*
Duties*
Start Date*

MonthDayYear
End Date*

MonthDayYear
YESNO
If NO, reason why not
(2) Employer's Name
Position Held
Supervisor's Name
Telephone

Area CodePhone Number
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
YESNO
If NO, reason why not
(3) Employer's Name
Position Held
Supervisor's Name
Telephone

Area CodePhone Number
Reason for Departure
Duties
Start Date

MonthDayYear
End Date

MonthDayYear
YESNO
If NO, reason why not
Please provide 3 references (work, education or church related).

NO FAMILY MEMBERS.
Reference (1) Name*
Reference (1) Telephone*

Area CodePhone Number
Reference (2) Name*
Reference (2) Telephone*

Area CodePhone Number
Reference (3) Name*
Reference (3) Telephone*

Area CodePhone Number
Please provide at least one emergency contact.
Emergency Contact (1)
Phone Number*

Area CodePhone Number
Emergency Contact (2)
Phone Number

Area CodePhone Number
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 J Boss Company LLD, dba Premier Cleaning Services, 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 Premier Cleaning Services policies, rules, and procedures. I understand that Premier Cleaning Services 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, unless otherwise specified, and I have no criminal charges pending against me.
**APPLICANT PLEASE NOTE**

1. It is agreed and understood that this application for employment in no way obligates Premier Cleaning Services to employ me.

2. My employment and compensation can be terminated with or without cause, and with or without notice at any time, at the option of either Premier Cleaning Services or myself.

3. I authorize investigation of all information provided in this application either prior to or after my employment. I understand that misrepresentation or omission of facts is cause for not employing me or cause for my dismissal if I am employed.

4. I acknowledge that at the time of termination, I will return all company property, such as keys, uniforms, etc. to company management.

5. I certify that the answers on this application are valid, and that I have not knowingly withheld any information that would unfavorably affect my consideration for employment.
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1451 W. 5175 S. #103, Riverdale, UT 84405, 801-393-5767

WORK HISTORY / EXPERIENCE

Please provide 3 references (work, education or church related).

False information will cause removal from our registry.