Address:
Are You Over 18 Years Old? YesNo
Do You Have? A smart phoneA 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
How Did You Hear About our openings? EmployeeAdOther - Please give short explanation
At your initial interview can you provide: Copy of a valid Driver's License YesNo Proof of Auto Insurance YesNo Current Auto Registration YesNo Proof of Authorization to work in the US (valid social security card) YesNo Ability to read, write, speak in English YesNo
Do you own your own vehicle? YesNo
Are you able to work flexible hours to obtain full time work? YesNo Graveyard Attendant or Day Time Attendant Graveyard AttendantDay Time Attendant
Schedule Restrictions:
Date Available: Salary Desired: Days available (Check all days you can work): MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Do you have any problems with (check all that apply): BackSpineRepetitive motionLegsAllergiesFears or phobiasNeckLiftingArmsHeadachesBending
Do you have problems with any physical limitations that would preclude you from performing the requirements of this job?
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. Explain your experience with any cleaning supplies you have utilized: 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
Full name Telephone Number Full name Telephone Number
Full name Telephone Number
Name Date Email
