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Join Our Team

We are always looking for new team members that enjoy cleaning, and are looking to serve the Birmingham metro area. To download and print our application please click here. You can also fill out the form below to complete your job application.

Application

Name*

Address

Country/Region*

Address*

City*

Zip / Postal code*

Phone Number*

Email*

Driver's License Number*

Driver's License State*

Social Security Number

Position Applied For

Are you a US citizen?*

Yes

No

Are you authorized to work in the United States?*

Yes

No

Have you ever been convicted of a felony?*

Yes

No

If yes, please explain

Education Level*

Did you graduate?*

Yes

No

References

Reference 1 Name

Reference 1 Relationship

Reference 1 Company

Reference 1 Address

Country/Region

Address*

City*

Zip / Postal code*

Reference 1 Email

Reference 1 Phone

Reference 2 Name

Reference 2 Relationship

Reference 2 Company

Reference 2 Address

Country/Region

Address*

City*

Zip / Postal code*

Reference 2 Email

Reference 2 Phone

Reference 3 Name

Reference 3 Relationship

Reference 3 Company

Reference 3 Address

Country/Region

Address*

City*

Zip / Postal code*

Reference 3 Email

Reference 3 Phone

Employment History

Employment 1 Company

Employment 1 Address

Country/Region

Address*

City*

Zip / Postal code*

Employment 1 Phone

Employment 1 Job Title

Employment 1 Supervisor Name

Employment 1 From Date

Employment 1 To Date

Employment 1 Responsibilities

Employment 1 May We Contact?

Yes

No

Employment 2 Company

Employment 2 Address

Country/Region

Address*

City*

Zip / Postal code*

Employment 2 Phone

Employment 2 Job Title

Employment 2 Supervisor Name

Employment 2 From Date

Employment 2 To Date

Employment 2 Responsibilities

Employment 2 May We Contact?

Yes

No

Employment 3 Company

Employment 3 Address

Country/Region

Address*

City*

Zip / Postal code*

Employment 3 Phone

Employment 3 Job Title

Employment 3 Supervisor Name

Employment 3 From Date

Employment 3 To Date

Employment 3 Responsibilities

Employment 3 May We Contact?

Yes

No

Availability

When do you prefer to work?

Day

Evening

Both

What days are you available to work?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Can you travel if needed?

Yes

No

Are you available on short term notice?

Yes

No

Are you willing to accept part time work?

Yes

No

Disclaimer and signature

I certify that my answers are complete and true to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Sign in the box or use the keyboard to type.

Signature field is empty.

Date

Month

Day

Year

Office Hours

M-F: 8AM - 5PM

Contact

(205) 860-9383

info@assurecleaningbham.com

Employment

Apply

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