Job Application Form

Name *

First

Last

Phone *

Email *

Address *

Address Line 1

City

State

Zip Code

Date of Birth *

Tell Us About Yourself

Check any of the following IF TRUE for you… *

I have a valid driver’s license (not just an ID card)
I would have no difficulty standing, bending, or kneeling in connection with performing necessary and normal cleaning duties
I can work around normal home pets (cats and dogs)

Have you even been convicted of ANY crime? *

Yes
No

If you HAVE been convicted of a crime, please describe below.

Please select any shifts below that you ARE AVAILABLE to work. *

Monday through Friday from 9 AM to 4 PM
Monday through Friday from 5 PM to 10 PM
Saturday from 9 AM to 4 PM
Sunday from 9 AM to 4 PM

NOTE – If you are responding to a job posting, check the shift for which the job posting was made.

If none of the above choices describe your availability to work, please tell us what specific days and times (start and end times) you are available to work (if one of the choices above fits your available, you do not need to complete this question).

Tell us anything else about yourself and why you are interested in working for us. *

Most Recent / Current Employer

Name of most recent / current employer

Approximate start date

Approximate end date (enter today's date if still employed)

Salary / Hourly Pay Rate

Salary Pay Period

per Hour
Per Week
Per 2 Weeks
Per Month

Reason for leaving

Address of most recent / current employer

Address Line 1

Address Line 2

City

State

Zip Code

Next Most Recent Employer

Name of next most recent employer

Approximate start date

Approximate end date

Salary / Hourly Pay Rate (copy)

Salary Pay Period (copy)

per Hour
Per Week
Per 2 Weeks
Per Month

Reason for leaving

Address of most recent / current employer

Address Line 1

Address Line 2

City

State

Zip Code