Personal Information:



Address:


Are You Over 18 Years Old?
YesNo

Do You Have?
A smart phone?A computer at home?

Month and Date You were Born:

Are you legally eligible for employment to work inside the United States of America? YesNo

In the last ten years have you been convicted of a crime other than minor traffic offenses? YesNo

How Did You Hear About our openings?

Have you ever been convicted of theft? If so Explain in detail

Explain Convictions:

At your initial interview can you provide:
Copy of a valid Driver's LicenseProof of Auto InsuranceCurrent Auto RegistrationProof of Authorization to work in the US (valid social security card)Ability to read, write, speak in English

Which will be your primary mode for this job (please select only one)
Public transportation (bus)Ride with a friend or family memberUber, cab, etc.Shared carOwn car

Position Information



Preferred Hours:
Schedule Restrictions:
Hours Available:
Date Available:
Salary Desired:
Days available (Check all days you can work):


Physical Information

Do you have any physical limitations that would preclude you from performing the requirements of this job?

List your software skills:

List the equipment you have used:

Do you have any problems with (check all that apply):

Are you able to:
Lift up to 30 lbs daily?                                                            YesNo
Walk up to 8 hours at a time?                                               YesNo
Stand up to 8 hours at at time?                                            YesNo
Perform cleaning duties up to 8 hours daily?                    YesNo
Mop, Dust, Vacuum, Clean all areas of the laundromat? YesNo
Wash - Dry - Fold Customers Clothing?                              YesNo

Employment History

Ever employed by this company?

Briefly describe, in a few sentences, your PAID experience performing commercial, janitorial, hotel or residential cleaning services.

May we Contact Your Present Employer?


Employer 1

Name
Address
Position Department Supervisor Contact number Date of employment Hours Worked Salary
Duties Reason for leaving

Employer 2

Name
Address
Position Department Supervisor Contact number Date of employment Hours Worked Salary
Duties Reason for leaving

Employer 3

Name
Address
Position Department Supervisor Contact number Date of employment Hours Worked Salary
Duties Reason for leaving

Professional references

Full name Contact number

Full name Contact number

Full name Contact number


Fill in the following then click the Submit button

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