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2024 Clean+Safe Employee Application

Demographics

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* 1. Full Name (First, Middle & Last)

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* 2. Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 3. Contact Information (complete all that apply)

Cell Phone:

Home Phone:

Work Phone:

Email Address (if available):

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* 4. May we contact you at work?

Yes

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* 5. Best time to contact you:

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* 6. Earliest date available for work:

Date / Time

Date

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* 7. Employment desired (select all that apply)

Part-time

Full-time

Daytime

Evening / Night

If interested in Part-Time only, please note how many hours per day / night you would prefer

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* 8. Position Applying

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* 9. What time are you available to start cleaning each day / evening?

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* 10. What is your desired wage or amount of pay per hour?

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* 11. How were you referred to this position or how did you find out about this position?

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* 12. Have you ever been employed with us before?

Yes (If yes, please include date in comment box below):

Date if applicable:

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* 13. Please list any reason(s) that would prevent you from janitorial labor
(i.e. lifting, standing, mopping, sweeping, cleaning etc. If so, please explain):

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* 14. Please list any acquaintances or relatives employed by Clean+Safe LLC:

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* 15. Have you ever been convicted of a felony?

Yes (If yes, please use comment box to explain)

Explain

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* 16. List prior work experience:

Company Name /
Supervisor / Contact #:

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* 17. Please add any comments that you feel important in our consideration of your application:

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* 18. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information is in my application or interview may result in my release. I authorize you to verify all information provided:

Yes

100% of survey complete.

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* 1. Full Name (First, Middle & Last)

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* 2. Address

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* 3. Contact Information (complete all that apply)

Question Title

* 4. May we contact you at work?

Question Title

* 5. Best time to contact you:

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* 6. Earliest date available for work:

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* 7. Employment desired (select all that apply)

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* 8. Position Applying

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* 9. What time are you available to start cleaning each day / evening?

Question Title

* 10. What is your desired wage or amount of pay per hour?

Question Title

* 11. How were you referred to this position or how did you find out about this position?

Question Title

* 12. Have you ever been employed with us before?

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* 13. Please list any reason(s) that would prevent you from janitorial labor (i.e. lifting, standing, mopping, sweeping, cleaning etc. If so, please explain):

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* 14. Please list any acquaintances or relatives employed by Clean+Safe LLC:

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* 15. Have you ever been convicted of a felony?

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* 16. List prior work experience:

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* 17. Please add any comments that you feel important in our consideration of your application:

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* 18. I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information is in my application or interview may result in my release. I authorize you to verify all information provided:

* 13. Please list any reason(s) that would prevent you from janitorial labor
(i.e. lifting, standing, mopping, sweeping, cleaning etc. If so, please explain):