Address:
Are You Over 18 Years Old? YesNo
Do You Have? A smart phone?A computer at home?
Month and Date You were Born: Social Security number (Last 4 digits, used to create your unique user ID)
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? EmployeeAdOther - Please give short explanation
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
What position are you applying for? Night time AttendantDay Time AttendantPart TimeFull Time Preferred Hours: Schedule Restrictions: Hours Available: Date Available: Salary Desired: Days available (Check all days you can work): MondayTuesdayWednesdayThursdayFridaySaturdaySunday
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): BackSpineRepetitive motionLegsAllergiesFears or phobiasNeckLiftingArmsHeadachesBending
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
Ever employed by this company? YesNo Briefly describe, in a few sentences, your PAID experience performing commercial, janitorial, hotel or residential cleaning services. May we Contact Your Present Employer? YesNo
Employer 1
Name Address Position Department Supervisor Telephone Number Date of employment Hours Worked Salary Duties Reason for leaving
Employer 2
Employer 3
Full name Telephone Number Full name Telephone Number Full name Telephone Number
Name Date Email