A F L Cleaning Services

* INDICATES REQUIRED INFORMATION

PERSONAL INFORMATION:

*Full (Legal) Name:

*Birth Date: (mm/dd/yyyy)

*Street Address

*City

*State

*Zip Code

County in which you live:

*Home Phone Number:

*Mobile Phone Number:

Email Address:

*Social Security Number: (xxx-xx-xxxx)

As conditions for employment, one must "own" dependable transportation AND possess "valid" drivers license.

Do you "OWN" dependable transportation AND possess a valid drivers license?

Yes
No

Please enter your valid drivers license information: state code (PA), License # (xx-xxx-xxx) and Expiration Date( mm/dd/yyyy).

*Position Applying For:

Cleaner:
Supervisor:
Other:

Title of Other Position Applying:

Date Available: mm/dd/yyyy

CITIZENSHIP:

*Are you a citizen of the United States of America?

Yes
No
No, But I'm legally authorized to work in the United States and have appropriate documents.

*Some of our clients require a clearance from the Pa State Police. Are you willing to agree to a background check as a condition of employment?

Yes
No

EDUCATION:

*Highest Level of Education Completed:

High School:
College - Associates or Bachelors Degree
Graduate School: Masters or Doctorate
None of the above.

Name and Address of School Completed and Dates Attended:

CURRENT EMPLOYMENT:

*Are you currently employed?

Yes
No

Name, Address and Phone # of Current Employer:

Current Job Title & Job Responsibilities:

Date you began your current employment:

May we contact your current employer?

Yes
No

PREVIOUS EMPLOYMENT:

Name, Address and Phone Number of Previous Employer:

Previous Job Title and Responsibilities:

Dates (From / To) of Your Previous Employer:

May we contact your previous employer?

Yes
No

Reason(s) why you left your previous employer:

Cleaning positions require physical tasks such as: standing long term, bending frequently, empty trash, mop, (both dust & wet), vacuum, lifting 30-50 lbs, and other physical tasks.

Do you have any physical limitations?

Yes
No

*If Yes, Please list all physical "limitations" you have including: Any injuries you may have sustained that may become irritated from cleaning related activities.

MILITARY SERVICES:

*Did you serve in the Military?

Yes - Honorable Discharge
Yes - Dishonorable Discharge
No

Branch of Military and Dates Of Service:

REFERENCES: (Please provide two professional and one personal, non-relative reference.)

*Professional Reference #1 - Please provide name, address, phone# and relationship to you.

*Professional Reference #2 - Please provide name, address, phone# and relationship to you.

*Personal Reference - Please provide name, address, phone# and relationship (non-relative) to you.

DISCLAIMER:

*Disclaimer: I certify that my answers are true and complete to the best of my knowledge. If this applications leads to employment, I understand that false or misleading information on my application or in the interview may result in my termination. Selecting Yes below indicates my agreement with this disclaimer.

Yes
No

ELECTRONIC SIGNATURE & DATE:

*Signature: By typing my full legal name in the space provided below for submission, all information is correct and my electronic signature represents my understanding as such.

*Today's Date: (mm/dd/yyyy)