Cleaning Your Way - Employment
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YOUR WAY CLEANING a division of Marshall Maintenance LLC
 
By submitting this form you hereby grant authority to Your Way Cleaning and Marshall Maintenance LLC to conduct investigations into your background including but not limited to: Criminal History, Previous Employment, Education, Medical History or any other investigation it deems appropriate.

By submitting this form you hereby release Your Way Cleaning, Marshall Maintenance LLC as well as any and all individuals, parties or organizations from any liability that may arise from disclosure of your personal information.

 
Full Name:
Address:
City:   State:   Zip:
Birthdate   US Citizen?:   Other Citizenship:
Email:
Phone:   Referred By:  
 
Which 2 major cross streets do you live near?
 and 
 
Time Commitment: Part-time Full-time No Preference
 
What experience do you have that will be helpful in this work?
 
What Days available to Work?: Monday Tuesday Wednesday
Thursday Friday Saturday Sunday
 
What time each day are you available to Work?:
Provide Year/Make of your auto, or other transportation:
Can begin work on:
 
Current Employment
Business Name:
Address:
City:   State:   Zip:
Date Started:   Rate of Pay:  
What Hours do you presently Work?:
Can you be reached on the job? Provide Phone Number:
 
Past Employment
From:
To:
Employer Name:
Employer Address:
Employer Contact:
Employer Phone:
Reason for Leaving:
 
From:
To:
Employer Name:
Employer Address:
Employer Contact:
Employer Phone:
Reason for Leaving:
 
May we contact your employer?: Yes
No
 
References: Name 3 persons, other than relatives) include address
Name: Phone:
Name: Phone:
Name: Phone:
 
Highest Level of Education Attained?:
 
Have you ever been convicted? Yes
No
If Yes, explain fully:
 
Have you any physical defects? Yes
No
If Yes, give details:
 
Were you ever injured? Yes
No
If Yes, give details:
 
Hearing defects? Yes
No 		  Vision? Yes
No 		  Speech? Yes
No
 
Does heat, standing on your feet or lifting cause you any difficulties? Yes
No
 
In case of emergency contact:  Phone:
 
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