Apply Here - Clean Source Inc.

Name *

First

Middle

Last

Address *

City/State *

Zip Code *

Primary Phone Number *

Are you 18 years or older? *

Yes
No

Date of Birth *

MM/DD/YYYY Date of Birth is used solely for employment verification and background screening purposes.

Have you worked for us before? *

Yes
No

How did you hear about us? *

Are you permitted to work in the U.S.? *

Yes
No

Employment Desired *

Full Time
Part Time

*Most positions are part-time evenings

What shift(s) are you available to work? *

Mornings
Evenings

*Most current openings are part-time evening positions. Applicants available for evening shifts may receive priority consideration.

Position Desired *

*Most positions are general cleaner

Do you have reliable transportation to and from work each scheduled shift? *

Yes
No

Do you have experience in any of the following? *

*Click all that apply

Have you ever been convicted of a felony or misdemeanor other than minor traffic violations? *

Yes
No

If you answered "Yes", please list the offense(s), date(s), and county/state where the conviction occurred.

Do you consent to criminal background check? *

Yes
No

Do you consent to a preemployment drug screening? *

Yes
No

Highest Level of Education Completed *

Have you served in the U.S. Armed Forces?

*If Yes, please provide branch of service, discharge date, and rank

Name of present or last employer *

*Please provide Company Name, Dates you were employed, Your Job Title, Salary, Supervisors Full Name, Supervisors Phone Number, Reason You Left

May we contact this employer? *

Previous Employer #2 (Optional)

*Please provide Company Name, Dates you were employed, Your Job Title, Salary, Supervisors Full Name, Supervisors Phone Number, Reason You Left

May we contact this employer?

Previous Employer #3 (Optional)

*Please provide Company Name, Dates you were employed, Your Job Title, Salary, Supervisors Full Name, Supervisors Phone Number, Reason You Left

May we contact this employer?

Professional Reference (Preferred)

*Please provide the reference’s full name, phone number, employer/company, and professional relationship to you (supervisor, manager, coworker, etc.).

May we contact this employer?

Do you hold any of the following certifications? (Supervisor and Floor Care Positions)

Date you can start? *

MM/DD/YYYY

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 from employment consideration or termination of employment. *

I Agree