Cleaning Job Application for Employment

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including, but not limited to, race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

What position are you applying for?

PERSONAL BACKGROUND

Name*

First Middle Last

Current Address*

Street Address, Apt # City State ZIP Code

How long at this address?*

less than 3 years
greater than 3 years

Prior Address

If less than 3 years at current address.

Street Address, Apt # City State ZIP Code

Your Email Address*

Enter Email Confirm Email

Phone*

Include area code

Best time to contact you?*

Best day to contact you?*

How did you hear about us?*

Internet
Referred by

Who referred you?

AVAILABILITY

What hours are you available to work on the following week days?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

EMPLOYMENT QUALIFICATIONS

Educational Background*

Select the highest level achieved.

Which of the following categories of jobs have you had?*

Check each category you have worked at.

Are you able to lift 50 pounds or more?*

Yes
No

Would you have difficulty standing, bending or kneeling in connection with performing the necessary cleaning duties?*

Yes
No

Do you have a current valid driver's license?*

Yes
No

Do you have your own vehicle?

Yes
No

Is it insured?

We will require proof of comprehensive liability insurance.

Yes
No

Can you provide verification of your legal right to work in the United States?*

We will obtain your Social Security Number at the time of your personal interview, and ask for verification of your legal work status and completion of I-9 form no later than 3 business days after hire.

Yes
No

Have you ever been bonded?*

Yes
No

Are you presently employed?*

Yes
No

May we contact your present employer?*

Yes
No

EMPLOYMENT HISTORY

List below your last three employers, starting with your present or last place of employment. You may include any verified work performed on a volunteer basis.

Job #1 - Dates Employed

Job #1 - Name and Address of Employer

Job #1 - Salary (per hour)

Job #1 - Position or Title

Job #1 - Briefly describe your job duties

Job #1 - What was your reason for leaving?

Job #2 - Dates Employed

Job #2 - Name and Address of Employer

Job #2 - Salary (per hour)

Job #2 - Position or Title

Job #2 - Briefly describe your job duties

Job #2 - What was your reason for leaving?

Job #3 - Dates Employed

Job #3 - Name and Address of Employer

Job #3 - Salary (per hour)

Job #3 - Position or Title

Job #3 - Briefly describe your job duties

Job #3 - What was your reason for leaving?

EMPLOYMENT REFERENCES

Provide the names of three (3) professional references whom you have known for at least three (3) years. You may include references from work performed on a volunteer basis. NOTE: References will not be contacted unless an offer for employment is made.

Reference #1 - Name*

First Last

Reference #1 - Occupation*

Reference #1 - Address*

Street Address City State

Reference #1 - Phone*

Include area code

Reference #1 - Years Known*

Reference #2 - Name

First Last

Reference #2 - Occupation

Reference #2 - Address

Street Address City State

Reference #2 - Phone

Include area code

Reference #2 - Years Known

Reference #3 - Name

First Last

Reference #3 - Occupation

Reference #3 - Address

Street Address City State

Reference #3 - Phone

Include area code

Reference #3 - Years Known

APPLICANT'S STATEMENT

In submitting this application, I certify that all of the foregoing information is a complete and accurate statement of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will constitute grounds for dismissal. I understand that if this application results in a subsequent personal interview for employment that I will be asked to furnish certain references concerning my work history. I acknowledge that each company is independently owned and operated and that each company is responsible for its own hiring and employment practices. I understand that prior to employment that the company will conduct any investigation necessary concerning any part of my background related to the position I am seeking, including, but not limited to, the obtaining of a police report and driving record. I understand and agree that, if employed, I will be responsible for familiarizing myself with all rules and regulations of the company as they presently exist or are later modified and that I will abide by its rules and regulations which I understand are subject to change. I also understand that no representative of the company has any authority to enter into any employment agreement for any specified period of time, or to assure me of any future position, benefits, or terms and conditions of employment. I further understand that, if hired, my employment is for no definite period of time and may be terminated by either party at any time.

Additional Comments

If there is anything you would like to add or explain further, please make comments here.

Acknowledgement*

I have read, understand and agree with the above
I do not agree

Comments

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