Name | Nombre *

First Name

Last Name

Date of Birth | Fecha de Nacimiento *

MM

DD

YYYY

Phone | Teléfono *

(###)

###

####

What is your preferred method of contact? | Cómo prefiere que lo contacten

Phone call

Text

Email

Do you have reliable transportation to work? | Tienes transporte para ir al trabajo? *

We are currently prioritizing applications from workers who can drive themselves–however, we are able to provide transportation for the right candidates.

Yes: Own car

Yes: Shared/family car

No, transportation required

House cleaning is a physically demanding task–you may be required to bend over, kneel, and lift up to 25 pounds. Do you feel comfortable with this? | ¿Se siente físicamente cómodo al agacharse, arrodillarse y levantar hasta 25 libras? *

Yes

No

Are you willing to take a background check? | ¿Estás dispuesto a realizar una verificación de antecedentes? *

We ask this because our clients' trust is very important to us–we make all efforts to keep their homes and belongings safe.

Yes

No

Reference 1

First Name

Last Name

Phone

(###)

###

####

Reference 2

First Name

Last Name

Phone

(###)

###

####