Join Our Team We Have a Place for You Employment Questionnaire Name: Address: Email: Phone #: US Citizen? Yes No If no, are you authorized? Yes No Current driver's license? Yes No Reliable transportation? Yes No Minimum required state auto insurance? Yes No High School Diploma or GED? If Yes, year graduated: Any Felony Convictions? Yes No If Yes, explain: Have you applied previously? Yes No If Yes, when? Work Experience Are you currently employed? Yes No If Yes, where? Schedule for current employment: Monday: Tuesday: Wednesday: Thursday: Friday: Saturday: Sunday: Most Recent 2 Jobs: (1) Employer (1) Dates Employed (From/To) (1) Title: (1) Responsibilities: (1) Start and End Salary (1) Reason for leaving: (2) Employer (2) Dates Employed (From/To) (2) Title: (2) Responsibilities: (2) Start and End Salary: (2) Reason for leaving: What would your availability be with Clean Office Exec? Monday available hours: Tuesday available hours: Wednesday available hours: Thursday available hours: Friday available hours: Saturday available hours: Sunday available hours: Job Requirements • Providing your own Background check from your local Sheriff’s Department • Bending/crouching • Lifting up to 60lbs. • Stretching/reaching • Standing for long periods of time • Walking/Carrying items up and down stairs • Random Drug/Alcohol tests Are you capable of fulfilling above listed job requirements? Yes No References (Professional and Personal) Name (Professional): Contact# (Professional): Relationship (Professional): Name (Personal): Contact# (Personal): Relationship (Personal): List 2 strengths: List 2 weaknesses: Additional Comments By electronically submitting: 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 in my application or interview may result in my release. Signature: Date: Security code
