Worker Application

*Required fields in purple

Name:
First

Middle

Last

Address:
Street

Apt#

City

County

State

ZIP

Day Phone:

Cell Phone:

E-Mail Address:

Social Security Number:

Person To Notify In Case of Emergency:
Name:

Phone Number:

Do you have a relative working at Maid to Perfection®?
(If yes, give name, relationship, department/location)
Yes   No
Name, Relationship, Department/Location

Have you ever been employed by Maid to Perfection®?
Yes   No
If yes, please complete:

Dates of Employment: From   To
Location:

Postition(s) Desired:

Full-Time   Part-Time   Either

Desired Work Schedule:

	Sunday	Monday	Tuesday	Wednesday
Start Time
Stop Time
	Thursday	Friday	Saturday
Start Time
Stop Time

Have you ever been convicted of a crime? If yes, Explain.
Yes   No  

Branch of Military (if applicable):

From:   To:

Rank Acheived:

Are you willing to drive?
Yes   No

Make, Model, Year, Color of Car

Education

High School	Name of School:
	Full Address:
	Major
	Number of Years
	Diploma/Degree
College	Name of School:
	Full Address:
	Major
	Number of Years
	Diploma/Degree
Other (specify)	Name of School:
	Full Address:
	Major
	Number of Years
	Diploma/Degree

Employment (List most recent job first):

Company:
Address:
Supervisor's Name:
Job Title/Duties Performed:
Phone Number:
Starting Pay: $	Ending Pay: $
From: Mo.   Yr.
To: Mo.   Yr.
Reason for Leaving:

Company:
Address:
Supervisor's Name:
Job Title/Duties Performed:
Phone Number:
Starting Pay: $	Ending Pay: $
From: Mo.   Yr.
To: Mo.   Yr.
Reason for Leaving:

Company:
Address:
Supervisor's Name:
Job Title/Duties Performed:
Phone Number:
Starting Pay: $	Ending Pay: $
From: Mo.   Yr.
To: Mo.   Yr.
Reason for Leaving:

May we contact your current employer?
Yes   No  

Personal References (Not Former Employers or Relatives)

Name:

Relationship or Title:

Phone Number:

Name:

Relationship or Title:

Phone Number: