application for employment
HomeAide Services is an equal opportunity employer.  In order to apply for a position as a
house cleaning associate, you must have the following:
~   your own reliable vehicle                  ~   a valid NC Driver's License
~   Social Security Card                         ~   Personal & Professional References
~   No criminal record of any kind          ~   Must speak, read & write English clearly
City                                         State                                         Zip
What was the last High School you attended?     Name, City & State
Did you attend a College or University?  Name, City and State
no
no
PREVIOUS EMPLOYMENT  (provide a minimum of two employers)
REFERENCES
(provide at least 3 references of friends, former employers or supervisors)
no
no
no
no
no
no
no
no
Are there any commitments that might prevent you
from being available for work?
HomeAide Services, Inc.
First Name
 M.I.
 Last Name
Street Address
Work Telephone
MobileTelephone
Home Telephone
When is the best time to call?
Driver's License Number & State
 E-mail Address
EDUCATION
What year did you graduate or obtain a G.E.D.?
Years attended
Did you finish?
Course of Study or Degree
2nd College or University, City and State
Years attended
Did you finish?
Course of Study or Degree
Most Recent or Current Employer's Name
 Contact Name
Employer's Address
 Employer's Phone Number
Position and Description of Duties
 Employment Dates
Salary or Rate
Reason for Leaving Employment
Previous Employer's Name
 Contact Name
Employer's Address
 Employer's Phone Number
Position and Description of Duties
 Employment Dates
Salary or Rate
Reason for Leaving Employment
Previous Employer's Name
 Contact Name
Employer's Address
 Employer's Phone Number
Position and Description of Duties
 Employment Dates
Salary or Rate
Reason for Leaving Employment
Previous Employer's Name
 Contact Name
Employer's Address
 Employer's Phone Number
Position and Description of Duties
 Employment Dates
Salary or Rate
Reason for Leaving Employment
Reference's Name     
 Reference's Phone Number
Reference's Address
 City, State
 Zip
How do you know this person?
 Years Known
Reference's Name     
 Reference's Phone Number
Reference's Address
 City, State
 Zip
How do you know this person?
 Years Known
Reference's Name     
 Reference's Phone Number
Reference's Address
 City, State
 Zip
How do you know this person?
 Years Known
PERSONAL INFORMATION
do you have a reliable vehicle?
can you read a map?
Are you afraid of animals?
Do you have house
cleaning experience?
Are you willing to work alone?
Do you speak any
language other than
english?
Are you currently employed?
Have you applied to this company
before?
What areas are you
willing to work?
Raleigh
 Carrboro
Durham
 Chapel Hill
 Hillsborough
Cary
 Holly Springs
 Fuquay Varina
Apex
 Garner
Knightdale
 Wake Forest
When will you be available to start work?
Why are you interested in this position?
Describe your cleaning experience?
What daytime hours are you available?
What are your top 3 priorities in life?
select the days
you are available
Tuesday
 Wednesday
Monday
Friday
 Saturday
Thursday
Professional Housecleaning