Deep Blue Clean

Application for Employment

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.

PERSONAL BACKGROUND

First Name *

Middle Name

Last Name *

Phone *

Email *

Present Adress

Street *

City *

State *

Postal code *

Mailing Address

Street *

City *

State *

Postal Code *

PREVIOUS ADDRESS: (If less than 5 years at present address)

Street

City

State

Postal/Zip Code

Person To Contact In Case of Emergency: *

Emergency Contact Phone Number: *

Email *

Are you at least 21 years of age? *

Yes

Do you speak and understand English? *

Yes, Fluent in English language

Yes, Conversational English (may struggle with formal language)

No, uses a translator app/ family

Do you know or are you related to anyone who works for deep blue clean? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

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

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Do you have full time access to a vehicle? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Is your vehicle in good working condition? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Is the vehicle covered by liability insurance? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

What Company? *

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

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Are you able to lift 25 pounds or more? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

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

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Are you allergic to Household Chemicals? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Are you allergic to cats and/or dogs? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Are you afraid of cats and/or dogs? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

What days are you available to work on the following weekdays? *

Monday

Tuesday

Wednesday

Thursday

Friday

What time will you typically START your shift? *

12:00 AM
1:00 AM
2:00 AM
3:00 AM
4:00 AM
5:00 AM
6:00 AM
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
No elements found. Consider changing the search query.
List is empty.

What time will you typically END your shift? *

12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
11:00 PM
No elements found. Consider changing the search query.
List is empty.

Is there anything specific about your schedule or availability that we should be aware of? Please feel free to mention if you have any recurring appointments, preferred days off, or if you'd prefer to start work at different times on specific days of the week.

Are you presently employed? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

If “yes”, may we contact your present employer? *

Yes
No
No elements found. Consider changing the search query.
List is empty.

Which of the following categories of jobs have you had? *

House Cleaning/ Maid Services

Office Desk

Landscape/Outdoor

Restaurant/ Fastfood Industry

Homemaker

Children/Daycare/Substitute Teacher

Janitorial/Custodian

Manufacturing

Hairdresser/Salon

Other

Please specify the category of job you had: *

Work Experience

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

From *

To *

Name and Address Of Employer *

Position *

Supervisor's Name *

Telephone Number: *

Reason for Leaving *

From *

To *

Name and Address Of Employer *

Position *

Supervisor's Name *

Telephone Number: *

Reason for Leaving *

From *

To *

Name and Address Of Employer *

Position *

Supervisor's Name *

Telephone Number: *

Reason for Leaving *

Educational Background: *

Select

Highschool
College
No elements found. Consider changing the search query.
List is empty.

Highest Grade Completed:

Highschool
Some College/Trade
Associate/Bachelors degree
Post Graduate
No elements found. Consider changing the search query.
List is empty.

Major Area of Study: *

Name of School and Location *

Have you ever been convicted of a criminal offense? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

If yes, please explain: *

Have you ever been bonded? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

Has your driver’s license ever been suspended? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

If yes, please explain:

Option 1
Option 2
Option 3
No elements found. Consider changing the search query.
List is empty.

Note: Due to the security-sensitive nature of the job the company conducts a criminal background check on any applicant in consideration of hiring.

PROFESSIONAL REFERENCES

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

Name *

Occupation *

Phone *

Years Known: *

Select

1
2
3
4
5
No elements found. Consider changing the search query.
List is empty.

Name *

Occupation *

Phone *

Years Known: *

Select

1
2
3
4
5
No elements found. Consider changing the search query.
List is empty.

Which of the following best reflects your primary motivation for applying to this position? * *

I NEED this job

I WANT this job

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

Can you adapt to changing work priorities and environments? *

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

Can you go without smoking for 4 hours? *

Select

Yes
No
No elements found. Consider changing the search query.
List is empty.

PLEASE READ CAREFULLY

AUTHORIZATION AND CONSENT FOR RELEASE OF INFORMATION

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 Deep Blue Clean, LLC, 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 Deep Blue Clean 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 Kentucky 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 Deep Blue Clean, LLC, 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 Full Name:

First Name *

Middle Name

Last Name *

Signature *

Clear

Enter your sign