Specialized Cleaner Application

Pre-Application Questions

Do you have a driver’s license? YesNo
Do you have a reliable vehicle? YesNo
Are you interested in Part time or Full Time? Part TimeFull Time
How many years experience do you have?
Are you willing to undergo a background check, in accordance with local law/regulations? YesNo
Are you authorized to work in the United States? YesNo
What is the highest level of education you have received?

Application Questions

Personal Information

Last Name
First Name
Middle Initial
Street Address
City
State
ZIP
Phone
How long at this address?
If less than 1 year, list previous address below
Do you Own or Rent? OwnRent
Landlord Name:
Landlord Phone:
Previous Street Address
City
State
ZIP
Phone
How long at this previous address?
Did you Own or Rent? OwnRent
Previous Landlord Name:
Previous Landlord Phone:
If you are married, is your spouse employed? YesNo
What is your spouse's first name?
Your social security number
Driver's license number
How did you hear about this position? (Friend, newspaper ad, online, etc)

Employment Desired

Position
When can you start?
Income desired
Are you presently employed? YesNo
If so, may we contact your present employer? YesNo

Education

Please provide name/location, years attended, date graduated, and subjects studied for each school and level of education that you've achieved (including grammar school, high school, college, and trade schools)

School
Name & Location of School
Years Attended
Date Graduated
Subjects Studied
Grammer School
High School
College
Trade/Business School

Special Questions

The information requested herein is required for bona fide occupational qualification and for other legally permissible reasons.

Are you a citizen of the United States? YesNo
If "No", are you a legal immigrant to the U.S.? YesNo
Date of Birth
Height
Weight
Color of Eyes
Have you ever been convicted of a felony? YesNo
If "Yes", when?
Has your driver's license ever been suspended? YesNo
If "Yes", explain.
Make of vehicle
Model
Vehicle License Plate #
License Plate State

*The Age Discrimination Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but no less than 70 years of age.

Physical Record

Do you have any physical defect, hearing problems, difficulty with vision or other ailments which might preclude you from performing or which you are currently being treated for? If so, please indicate.
In case of emergency, notify:
Phone

Former Employers

(List last 4 employers, starting with the last one first)

Dates Employed From/To (Month/Year)
Name & Phone Number of Employer
Salary
Position
Reason For Leaving

Personal References

(List below the names of 3 persons not related to you, whom you have known for at least one year)

Name
Address
Business
Phone