References will be checked only after completing in-person interview. Please don’t list significant others or family. Co-workers and managers are best.

First & Last Name

Email Address

Phone Number

Date Available To Start

Street Address

City

State

Are you eligible to work in the United States? Are you eligible to work in the United States? Yes No

Have you graduated from high school or earned a GED? Have you graduated from high school or earned a GED? Yes No Working on it

How many jobs have you had in the last 3 years? -- How many jobs have you had in the last 3 years? --012345+

If you are currently employed, why are you looking for a new job?

If you are not currently employed, how long have you been unemployed?

Why did you leave your last job?

Are you able to pass a background check? Are you able to pass a background check? Yes No

Are you tobacco & drug free? Are you tobacco & drug free? Yes No

Are you able to pass a drug test? Are you able to pass a drug test? Yes No

Do you have previous cleaning experience? Do you have previous cleaning experience? Yes No

Do you have a reliable vehicle? Do you have a reliable vehicle? Yes No

What hours are you available on Mondays?

What hours are you available on Tuesdays?

What hours are you available on Wednesdays?

What hours are you available on Thursdays?

What hours are you available on Fridays?

Reference #1 - Full Name

Reference #1 - Relation

Reference #1 - Company Name

Reference #1 - Phone Number

Reference #2 - Full Name

Reference #2 - Relation

Reference #2 - Company Name

Reference #2 - Phone Number

Reference #3 - Full Name

Reference #3 - Relation

Reference #3 - Company Name

Reference #3 - Phone Number

Any additional comments