Simply Cleaner 712-256-0522 612 E Pierce St. Co.Bluffs, IA 51503
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Application for Employment
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Indicates required field
Full Legal Name
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First
Last
Home Mailing Address
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City, State, Zip
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Home Phone
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Cell Phone
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Email
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Are you at least 16 yrs old?
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Yes
No
Do you have a work permit? Select one below:
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Yes
No
Plan to get one
Not Applicable
How did you hear about Simply Cleaner? Select One
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Friend or Family
On Line
Newspaper
Name of friend or family member that told you about Simply Cleaner or type N/A
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Position you are applying for? (Cleaner, Lead, Supervisor)
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Are you a legal US Citizen?
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Yes
No
What state were your born in?
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Do you have a current valid Drivers License
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Yes
No
What state is your Drivers Lisence
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Have you ever been convicted of a crime?
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Yes
No
If yes, explain briefly or type "N/A"
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Do you give Simply Cleaner permission to conduct a background check and drug test?
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Yes
No
SS # (all information is strictly confidential and not used for any other reason than a background check for employment.) You may also type in "N/A" and we will call you for your SS # over the phone.
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Do you have your own vehicle to get you to and from work?
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Yes
No
Do you have auto liability insurance on your vehicle you will use for work?
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Yes
No
Current Employer
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How long have your worked for your current employer?
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May we contact your current employer?
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Yes
No
Current Salary or Wage
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Available start date
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Can you lift 30 lbs?
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Yes
No
Any Medical Restrictions?
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Yes
No
Select your availability below.
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Monday Evenings
Tuesday Evenings
Wednesday Evenings
Thursday Evenings
Friday Evenings
Saturday Mornings
Saturday Afternoons
Please share how many hours week you would like to work
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Example: Monday - 9am-1pm, 5pm - 9pm Tuesday - Not Available
Employment History - List name, address, job title, dates worked and reason for leaving for the last 3 places you have worked.
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Name and Address of Last School Attended
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References: List 3 references, two professional and one personal. Name and Phone Number Required
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I certify that the information contained in this application is correct tot he best of my knowledge and understand that falsification or material misrepresentation of this information is grounds for refusal to hire or, if hired, involuntary termination. Applicant's online signature required below.
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Today's Date
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Notice: This application is not a contract for employment. Anyone is free to leave Simply Cleaner at any time and for any reason. Likewise, Simply Cleaner is free to terminate any employee at any time and for any reason. Simply Cleaner does not use employment contracts or guarantee employment for a specific time, location, or for any number of hours per week. Simply Cleaner can and does assign employees to different accounts at various times for the good of the company. Any representations to the contrary by anyone are disavowed.
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