Housekeeping Application Form

First Name *

Last Name

Phone *

Email *

Enter your 11 digit national ID number *

Emergency Contact Name:

Emergency Phone Number:

Are you applying for full-time or part-time employment?

Are you available for live-in assignments if needed?

When can you start?

Do you have reliable transportation?

Are you willing and able to travel to clients’ homes?

Do you have location preferences for assignments?

Do you have previous housekeeping experience?

If yes, how many years of experience do you have?

Where have you worked as a housekeeper before?

What were your main duties?

Which of the following tasks are you experienced in? (Check all that apply)

Do you have experience cleaning in homes with elderly or ill persons?

Are you comfortable working in homes where clients may be sick or recovering?

Do you understand the importance of hygiene and infection control?

Do you have any infection control training?

Why do you want to work with Serve With Grace Nursing And Home Services?

What does providing excellent service mean to you?

How do you handle working independently in someone’s home?

Have you ever been dismissed from a job? *

If yes, please explain:

Are you willing to undergo a background check if required? *

Reference 1

Reference Name

Relationship To Reference

Reference Phone Number

Reference Employer / Company:

Reference 2

Reference Name

Relationship To Reference

Reference Phone Number

Reference Employer / Company:

Are you physically able to perform cleaning duties such as bending, lifting, and standing for extended periods?

Signature

Today's Date

I certify that the information provided is true and accurate. I understand that false information may result in disqualification or termination.