Provider Application For House Cleaning

General Information

First Name *

Last Name *

City & State Where You Currently Reside *

Available Start Date:*

Current Employment Status:*

Employed

Self-Employed

Unemployed

Student

Email *

Phone *

Best Time To Call*

Morning

Afternoons

Evenings

Weekends

Are You Fluent in English or Able To Hold a Conversation in English? *

Yes

No

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Professional Information

Company Name if Applicable

Website

Do You Have a Cleaning Partner? If Yes, Please Put Down Their Name *

How Many Clients Do You Currently Clean For? *

Hours Available Weekly? *

Are You Self Equipped To Take On Residential Jobs? *

Yes

No

Explain In Detail Your Paid Cleaning Experience *

What Cleaning Companies Have You Cleaned For Previously? Please list them below *

Will You Be Able to Provide 3 Professional Cleaning References? *

Yes

No

Is There Any Specific Task That You Don't Perform? *

Have You Ever Used Green Cleaning Products? If Yes, How Would You Rate Them Compared to Products You've Traditionally Used? *

Are You Authorized to Work in the US? *

Yes

No

Do You Have a Valid Drivers License? *

Yes

No

Do You Have Reliable Transportation? *

Yes

No

Are You Bonded And Insured? *

Insured

Bonded

Neither

If You Are Not Currently Insured, Are You Willing and Able to Obtain Insurance Before Working With Us? *

Yes

No

I'm already insured

Active insurance is required before any work is assigned.

Please Tell Us About A Time You Went Above & Beyond For A Client *

Please Tell Us About A Time You Had A Dissatisfied Client & How You Handled The Situation *

Tell Us Something About Yourself *

Do You Offer Any Other Services? If Yes, List Them Here

This is a 1099 contract position and not a W2 position. *

I understand that I am responsible for my taxes and will be receiving a 1099 every year