Elderly Cleaning Services, LLC
Contact Us: 978.552.9533
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Application for Employment 
Present Address:
Position applying for:
Telephone:
How long?
Applicant Full Name:
Desired salary:
APPLICANTS WILL BE TESTED FOR 
ILLEGAL DRUGS AND CORI
PLEASE COMPLETE ENTIRE PAGE   
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​Weekly hours?
​​Have you had any accidents during the past three years? How many?
When can you start?
NO:
​Do you have insurance on your vehicle and can you provide proof? 
YES:
​Do you have a valid driver's license? 
If YES how Many?
YES:
NO:
State of issue:

Expiration date:
Have you had any moving violations during the past three years? 
YES:
NO:
Copyright © 2013-2018, Elderly Cleaning Services, LLC All Rights Reserved.  
 Location: Massachusetts * Phone: 978.552.9533
 Email address: elderlycleaningservices@gmail.com
Date of birth:
Employment Disclaimer: I certify that I have fully and accurately answered all questions and have given all information requested in this application for employment, and I understand that any wrong or incomplete information on the form may disqualify me for further consideration for employment or, if discovered during interview and or after I am hired, may be grounds for my immediate dismissal. I understand that all such information is subject to verification by Elderly Cleaning Services, LLC, and hereby give my consent to Elderly Cleaning Services, LLC to investigate my background and qualifications using any means, sources, and outside investigators at its disposal. I agree to undergo a CORI check, any type of drug and/or alcohol testing that Elderly Cleaning Services, LLC may require at any time. Finally, I understand this is a preliminary employment application and that submission of this application does not necessarily mean that I will be hired.
X Date:
Signature:
Do you have reliable transportation?
YES:
TRANSPORTATION:
NO:
YES:
NO:
Work Opportunity
Elderly Cleaning Services is seeking a house cleaner with a desire to help clean homes for our elderly 60+. Our priority is to provide a safe and refreshingly clean healthy environment for our Elders who need help with chores around their home. To ensure the safety of our elders, potential workers MUST be willing to take and pass a back ground check and drug test. We are a trusted company and have a tremendous impact within the elderly community by offering a service our elders want, need and deserve!
Job Description:
* Part time-year round work not seasonal
Cleaning experience preferred
* Paid training depends on experience
* Must be available 15-25 hrs/weekly to start
* Must be extremely honest at all time
* Caring and Reliability
* Must have valid driver's license
* Must have a vehicle with proof of insurance
* Must be willing to take and pass aback ground check and drug test

TODAY'S DATE:
DISCLAIMER: Here at Elderly Cleaning Services we work hard to protect the privacy of our website visitors. Our website forms require individuals to 
disclose information such as name, address, e-mail address and phone number. This information is used solely by Elderly Cleaning Services to respond to  requests and to occasionally notify individuals about important changes to our website and services. We will never sell share or transfer your information to third parties. “Elderly Cleaning Services reserves the right to refuse service to anyone and for any reason”.
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