Solicitud en Español Cleaner's Application Today’s Date: Position Desired: Hourly Salary Desired: About You Last Name: First Name: Address: City: State: Zip Code: Cell Phone: Date of Birth: Social Security Number (###-##-####): Can you legally work in the US? SELECTYESNO Do you have proof of right to work within the United States? SELECTYESNO Do you have a car? SELECTYESNO Do you have insurance? SELECTYESNO Insurance Company: Do you like pets? SELECTYESNO Emergency Contact Name: Education High School: High School Address: Did you graduate? SELECTYESNO Graduation Year: Language Skills English - FluentEnglish - only a littleSpanish - FluentSpanish - only a littleFrench - FluentFrench - only a littleVietnamese - FluentVietnamese - only a little Cleaning Skills MoppingSweepingVacuumingStripping BedsDustingClean KitchenClean Bathrooms References Reference 1 Name: Phone: Work/Duration: Reference 2 Name: Phone: Work/Duration: Reference 3 Name: Phone: Work/Duration: A Little More About You Signature Print Name: Signature (type full name): Date Signed: By submitting this application, you affirm under penalty of perjury that all information is true and accurate to the best of your knowledge.
