Lily-White Cleaning Services Application

Personal Information

First Name *

Last Name *

Phone Number *

Email Address *

Home Address *

Date of Birth

Are You 18 or Older? *

Position & Availability

Experience & Skills

Years of Cleaning Experience

Worked for a Cleaning Company Before?

Yes No

Describe Your Cleaning Experience

Most Recent Employment

Employer Name

Job Title

Dates Employed

Reason for Leaving

Supervisor Name & Phone

Professional References

Reference 1 — Name

Reference 1 — Phone

Reference 1 — Relationship

Reference 2 — Name

Reference 2 — Phone

Reference 2 — Relationship

Additional Information

Reliable Transportation?

Yes No

Valid Driver's License?

Yes No

Authorized to Work in the US?

Yes No

Willing to Pass Background Check?

Yes No

How Did You Hear About Us?

Languages Spoken

Additional Comments or Questions

Certification

I certify that the information provided in this application is true and complete to the best of my knowledge. I understand that false or misleading information may result in disqualification or termination.

Full Name as Signature *

Now Hiring

Thank You!