Online Application

Date:		E-Mail:
*First Name:		*Street Address:
*Last Name:		*City:
*Phone #:		*State:		*Zip:
When is the best time to contact you?   Please select 8:00am - 9:00am 9:00am - 10:00am 10:00am - 11:00am 11:00am - 12:00pm 12:00pm - 1:00pm 1:00pm - 2:00pm 2:00pm - 3:00pm 3:00pm - 4:00pm 4:00pm - 5:00pm 5:00pm - 5:00pm 6:00pm - 7:00pm 7:00pm - 8:00pm
How did you hear about us?    Please select Newspaper Ad Magazine Ad Flyer It's Maid Day Employee Internet Search Other
List name of Newpaper, Magazine, Employee, or Other:
Have you worked in the cleaning industry before?   Yes  No
List any relevant experience:
Position Applying For:   Full-Time  Part-Time
Date Available to Start Work:    (mm/dd/yyyy)
Hours Available to Work:   Please select Full Day (7:30am - 5:00pm) Mornings Only (7:30am - 12:30pm Afternoons Only (12:30pm - 5:00pm)
Days Available to Work:      M  Tu  W  Th  F  S  Su
Are you legally entitled to work in the United States?   Yes  No
(You must be a legal citizen of the United States or provide supporting documentation allowing you to work.)
Are you willing to submit to a drug test?   Yes  No
Are you willing to submit to a background check?   Yes  No
Have you ever been convicted of a felony or theft including misdemeanor convictions? (If yes, please explain):   Yes  No
Are there any skills, experience, or other qualifications which you feel would assist you in performing the duties of the position you have applied for?
List below your last two employers, starting with the most recent:
Employer's Name:
Start Date:   (mm/dd/yyyy)		End Date:   (mm/dd/yyyy)
May we contact this employer? (If not, state reason):   Yes  No
Reason for Departure:
Position(s) Held:
Duties:
Employer's Name:
Start Date:   (mm/dd/yyyy)		End Date:   (mm/dd/yyyy)
May we contact this employer? (If not, state reason):   Yes  No
Reason for Departure:
Position(s) Held:
Duties:
Please enter the Anti-spam Security Code: