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 Telephone Number Date of employment Hours Worked Salary
    Duties Reason for leaving

    Employer 2

    Name
    Address
    Position Department Supervisor Telephone Number Date of employment Hours Worked Salary
    Duties Reason for leaving

    Employer 3

    Name
    Address
    Position Department Supervisor Telephone Number Date of employment Hours Worked Salary
    Duties Reason for leaving

    Professional references

    Full name Telephone Number

    Full name Telephone Number

    Full name Telephone Number


    Fill in the following then click the Submit button

    Name Date Email