Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birth Date: *

MM

DD

YYYY

Do you have professional cleaning experience? *

Yes

No

Are you authorized to work in the U.S.? *

Yes

No

Have you ever been convicted of a felony? *

Yes

No

Do you consent to a background check? *

Yes

No

Are you currently employed? *

Yes

No

May we contact your current or previous supervisors for a reference? *

Yes

No

Do you have a reliable vehicle? *

Yes

No

Do you have a working cell phone with reliable internet? *

Yes

No

Are you able to wash and dry your own cleaning rags at home? *

Yes

No

By checking this box, I certify that my answers are true and complete to the best of my knowledge. *

I agree

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. *

I agree

Today's Date: *

MM

DD

YYYY