Welcome to your first step in joining
the Maid For You team!
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We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally protected basis, including, but not limited to, race, age, color, religion, sex, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

 
First Name *

 
Middle Initial

 
Last Name *

 
Current Address *

 
Current City *

 
Current State *

 
Current Zip *

 
Do you have a different mailing address?

     
 
Mailing Address

 
Mailing City

 
Mailing State

 
Mailing Zip

 
Previous Address

 
Previous City

 
Previous State

 
Previous Zip

 
Cell Phone

 
Other Phone

 
Emergency Contact Name

 
Emergency Contact Phone

 
Drivers License Number:

 
State Issued:

 
How did you hear about this job?

 
Do you know or are you related to anyone currently or previously employed by Maid For You?

     
 
If yes, please provide name and relationship:

 
Driving is a requirement of the job. Is your license valid?

     
 
Do you have full time access to a vehicle?

     
 
Is your vehicle in good working condition?

     
 
Is the vehicle covered by liability insurance?

     
 
If yes, what company?

 
Policy Number:

 
Make of Vehicle:

 
Model:

 
Year:

 
Are you able, at the time of employment, to submit
Verification of your legal right to work in the U.S.?*

     
 
*Verification and completion of the I-9 form must be submitted no later than 3 business days after hire.

 
Are you able to lift 25 pounds or more?

     
 
Would you have difficulty standing, bending, or kneeling in connection with performing necessary cleaning duties?

     
 
Are you allergic to Household Chemicals?

     
 
Are you allergic to cats and/or dogs?

     
 
Are you afraid of cats and/or dogs?

     
 
What hours are you available to work on the following weekdays?

 
Monday


 
Tuesday


 
Wednesday


 
Thursday


 
Friday


 
Saturday


 
Sunday


 
If hired, when can you start work?

 
Are you presently employed?

     
 
If “yes” may we contact your present employer?

     
 
Which of the following categories of jobs have you had?


 
Employment History: List your last three employers, starting with your present or most recent place of employment. You may include in such history any verified work performed on a volunteer basis.

 
Employer

 
Start Date

 
End Date

 
Supervisor

 
Phone Number

 
Salary

 
Position

 
Reason For leaving

 
Prior to that positon, where were you employed?

 
Employer

 
Start Date

 
End Date

 
Supervisor

 
Phone Number

 
Salary

 
Position

 
Reason For leaving

 
Prior to that positon, where were you employed?

 
Employer

 
Start Date

 
End Date

 
Supervisor

 
Phone Number

 
Salary

 
Position

 
Reason For leaving

 
Education History

 
High School Name and Location

 
General Area of Study

 
College

 
School Name and Location

 
General Area of Study

 
Trade, Business or
Graduate School

 
School Name and Location

 
Highest grade completed

 
General Area of Study

 
Have you ever been convicted of a criminal offense?

     
 
If yes, please explain:

 
Have you ever been bonded?

     
 
Has your driver’s license ever been suspended?

     
 
If yes, please explain:

 
Note: Due to the security-sensitive nature of the job, all employees are required to be bonded. As a matter of policy, the company conducts a police background and driving record check on any applicant in consideration of hiring.

 
List the names of three persons not related to you, whom you have known at least three years.

 
Reference 1

 
Name:

 
Address:

 
City, State, Zip:

 
Phone:

 
Occupation:

 
Years Known:

 
Reference 2

 
Name:

 
Address:

 
City, State, Zip:

 
Phone:

 
Occupation:

 
Years Known:

 
Reference 3

 
Name:

 
Address:

 
City, State, Zip:

 
Phone:

 
Occupation:

 
Years Known:

 
Check ONLY one box: *

(hint: there is no “right or wrong” answer, we just want to know you better in order to fill your schedule)

 
Why are you interested in working for Maid For You?

 
Why do you think you are a good fit for this company?

 
How long do you see yourself working here?

 
AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION

PLEASE READ THE FOLLOWING INFORMATION VERY CAREFULLY

 
I, the undersigned, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements will be considered as cause for possible dismissal. *

     
 
I authorize Maid For You, and any security agency service working for them, to disclose orally and in writing the results of this verification process and/or interview to the designated authorized representative of this company. *

     
 
I have read and understand this release and consent, and authorize the background verification. I authorize persons, schools, current and former employers, personal references and other organizations and Agencies to provide Maid For You with all information that may be requested, and to conduct a verification, as deemed necessary by this Company to fulfill the job requirements, with regards to my motor vehicle records, credit history as allowed by EEOC and ECOA, and to receive any criminal history record information pertaining to me which may be in the files of any Federal, State or Local criminal justice agency in Pennsylvania or any other States. I hereby release all the persons and Agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy of this document is as valid as the original. All results will be proprietary and will be kept CONFIDENTIAL and disclosed orally and in writing only to the designated authorized representatives of this Company and its Clients. *

     
 
I do hereby agree to forever release, discharge and indemnify Maid For You and their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting of information. *

     
 
Applicant Digital Signature *

*By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
 
Birthdate:

 
SSN:

 
Maiden Name:

 
State of Birth:

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The Maid For You
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