* If you would prefer to print and postal mail your application, * please CLICK HERE                     Home Town Housekeeping Application PERSONAL INFORMATION Last Name: First name and MI: Street address: City: State: Zip Code: Email:     Home phone: Cell phone: Have you ever been convicted:   YES   NO Are you 18 yrs or older?:   YES   NO DESIRED EMPLOYMENT Date you can start: Currently employed:   YES   NO Salary desired: May we inquire of your present employer: YES   NO Who referred you to this company: EDUCATION LEVEL Highest Education Level Give Address: EMPLOYMENT HISTORY Present or Last Employer: Start date: End Date: Description of work: Address: Phone: Name of Supervisor: Wage: Reason for Leaving: Other Previous Employer: Start date: End Date: Description of work: Address: Phone: Name of Supervisor: Wage: Reason for Leaving: Availability    Start Time    End Time Monday       Tuesday       Wednesday       Thursday       Friday       Authorization: By submitting this form, I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal and otherwise and release the company from all liability for any damage that may result from utilization of such information. I understand and agree to the above statement: Please check. Questions - Comments Back To Previous Page Home  |  Pay By Credit Card Hometown Housekeeping Carpet and Upholstery Cleaning P.O. Box 215 DuPont, WA 98327 DuPont/Steilacoom 253.964.3141 Lacey 360.455.8234 Dar's By Design