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    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?

    Do you have proof of right to work within the United States?

    Do you have a car?

    Do you have insurance?

    Insurance Company:

    Do you like pets?

    Emergency Contact Name:

    Education

    High School:

    High School Address:

    Did you graduate?

    Graduation Year:

    Language Skills

    Cleaning Skills

    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.