maidEZhiring.com
Baton Rouge
New Orleans
Come home to a clean home!
Employment Application
Date
We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recognized basis, including, but not
limited to, race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or
any other legally protected basis.
Personal Information:
Last Name
 MI
 First Name
Street Address
City
 State
 Zip
Telephone:
 Email Address
Social Security No.
Driver's License or State ID #
State
______________________________________________________________________________________________________________
Job-Related Information
Are you able to lift 40 pounds or more?
Yes
 No
Would you have difficulty standing, bending, or kneeling in connection with
performing necessary cleaning duties?
 Yes
No
What hours are you available to work on the following days?
Monday
 From
 To
Tuesday
 From
 To
Wednesday
 From
 To
Thursday
 From
 To
Friday
 From
 To
Saturday
 From
 To
Sunday
 From
 To
If hired, when can you start work?
Are you presently employed?
 Yes
No
If yes, may we contact your employer?
 Yes
No
Which of the following categories of jobs have you had?
House Cleaning
 Hotel/Motel
 Restaurant
 Fast Food
Janitorial
 Sales
 Manufacturing
Other
___________________________________________________________________________________________________________________________________________________
Work Experience
List below your last three employers, starting with your present or last place of employment. You may include in such history any verified
work performed on a volunteer basis.
From
Date
 To
Date
Most
Recent
Job
 Name of Employer
 Employer's Address
 Salary
 Reason for leaving
Supervisor's Name:
 Telephone :
___________________________________________________________________________________________________________
From
Date
 To
Date
Previous
Job
1
 Name of Employer
 Employer's Address
 Salary
 Reason for leaving
Supervisor's Name:
 Telephone :
___________________________________________________________________________________________________________
From
Date
 To
Date
Previous
Job
2
 Name of Employer
 Employer's Address
 Salary
 Reason for leaving
Supervisor's Name:
 Telephone :
______________________________________________________________________________________________________________
References
1
Name
 Occupation
 Phone
 Email
 Years Known
2
Name
 Occupation
 Phone
 Email
 Years Known
3
Name
 Occupation
 Phone
 Email
 Years Known
______________________________________________________________________________________________________________
PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY BEFORE SIGNING THIS APPLICATION. ONLY THOSE APPLICATIONS
WHICH ARE SIGNED AND DATED ARE CONSIDERED VALID. IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE
ASK BEFORE SIGNING.
Yes
 No
 In signing this application, I certify that all of the foregoing information is a complete and accurate statement
of the facts and understand that if any misrepresentation, omission or falsification be discovered, it will
constitute grounds for dismissal.
Yes
 No
 Have you ever been convicted of a criminal offense?
Yes
 No
 I hereby authorize maidezhiring to conduct any investigation necessary concerning any part of my
background including, but not limited to,the obtaining of a background check and drug test.
Yes
 No
 I hereby certify that I do not consume illegal substances of any kind and acknowledge that I will be required to
take a drug test as a condition of employment.
Yes
 No
 I authorize any of the persons or organizations named in this application to provide complete information and
records regarding my employment, education, character and qualifications. I release all parties from any
liability in connection with the provision an use of such information.
Yes
 No
 I understand and agree that, if contracted by MaidEZHiring or its client (s), I will be responsible for
familiarizing myself with all rules and regulations of the company as they presently exist or are later modified
and that I will abide by its rules and regulations which I understand are subject to change.
Yes
 No
 I also understand that no representative of the company has any authority to enter into any employment
agreement for any specified period of time, or to assure me of any future position, benefits, or terms and
conditions of employment. I further understand that, if hired, my employment is for no definite period of time
and may be terminated by either party at any time.
I have read, understand and agree with the above.
Legally Binding Digital Signature
Date
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