Luxury Cleaning Services

Luxury Cleaning Services

Giving you the luxury of time...

Employement Application Form

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About Us

Please do not call us. Fill out the form below, and click the Submit button at the bottom. We will email you back with a response, or contact you by phone. All information entered below is kept strictly confidential and private.

Personal Contact Information:
First Name:
Last Name:
Street Address:
City:
State:
Zip:
Day Phone:
Evening Phone:
E-Mail:
What is the best way to reach you?	Email Day Phone Evening Phone
Date Available For Work:
Are You Over 18 Years Old?:	Yes No
Are you a citizen of the United States?:	Yes No
If no, are you authorized to work in the United States?:	Yes No
Have you ever worked here before?:	Yes No
If yes, when?:
Have you ever filed for a workers comp. claim?:	Yes No
Have you ever been convicted of a felony?:	Yes No
If yes, explain:


Education:
High School:
High School Address:
From:
To:
Did you graduate?:	Yes No

College:
College Address:
From:
To:
Did you graduate?:	Yes No

Other:
Other Address:
From:
To:
Did you graduate?:	Yes No

References: Please provide three (no family members)
Full Name:
Relationship:
Company:
Phone:
Address:

Full Name:
Relationship:
Company:
Phone:
Address:

Full Name:
Relationship:
Company:
Phone:
Address:

Previous Employement: Start with your most recent job
Company:
Phone:
Address:
Supervisor:
Job Title:
Start Pay:
End Pay:
Job Duties:
From:
To:
Reason for Leaving:
May we contact your supervisor?:	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Start Pay:
End Pay:
Job Duties:
From:
To:
Reason for Leaving:
May we contact your supervisor?:	Yes No

Company:
Phone:
Address:
Supervisor:
Job Title:
Start Pay:
End Pay:
Job Duties:
From:
To:
Reason for Leaving:
May we contact your supervisor?:	Yes No

Military Service:
Branch:
From:
To:
Rank:
Type of Discharge:

Disclaimer and Signature:
By clicking Yes. You certify that your answers are true and correct to the best of your knowledge, and any false or misleading statements may be grounds for termination:	Yes No