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Job Application Form
Title:
Mr.
Mrs.
Ms.
First Name:
Last Name:
Age category
Under 20
21 - 30
31 - 40
41 - 50
51 - 60
60+
Phone:
Email:
Address:
Please select the city
Coquitlam
Surrey
Please describe yourself:
Do you have a business licence?
No
Yes
Are you bonded and insured?
No
Yes
Do you have a valid driver licence?
No
Yes
Do you have a vehicle?
No
Yes
Are you able to provide your own supplies (i.e. vacuum, mop, cleaning products, etc.)?
No
Yes
What type of cleaning you would like to provide?
Move in/out
No
Yes
One time
No
Yes
Same Day
No
Yes
Regular
No
Yes
After construction
No
Yes
Pick which city (or cities) in which you would like to provide cleaning services.
Coquitlam
No
Yes
Surrey
No
Yes
What days are you available ?
Sun
Mon
Tue
Wed
Thu
Fri
Sat
6am-9am
9am-12pm
12pm-3pm
3pm-6pm
6pm-9pm
9pm-12am
12am-3am
3am-6am
Do you have experience providing house cleaning services?
No
Less then 1 year
1 - 3 years
More then 3 years
Please give a brief summary of your skills and work experience.
Can you provide client references?
No
Yes
If yes, please list 2 professional references. Note: friends and family members are not suitable references.
Reference #1
Reference #2
Are you able to communicate with clients (English)
in writing
orally
What language(s) do you speak (other than English)
What is your expected hourly rate? $
By submitting this form, I confirm that the information I have provided is correct, that I have the legal right to work in Canada, and that I am at least 19 years of age.