Peoria: 309-966-1230
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Name (or Company Name if Sub Contractor)
First
Last
Primary Phone Number
*
111-222-3333
Secondary Phone Number
111-222-3333
Email
*
Date of Birth
*
MM slash DD slash YYYY
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
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Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
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Belgium
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Bouvet Island
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Cook Islands
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Venezuela
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Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
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Zambia
Zimbabwe
Åland Islands
Country
What position are you applying for?
*
Peoria area nightly kleener
Washington area nightly kleener
Bloomington nightly kleener
St. Louis area nightly kleener
Do you have your own tools?
Yes
No
FEIN #
Do you carry Workers' Comp Insurance?
Yes
No
Do you have any snow customers of your own?
Yes
No
Do you have equipment available for snow removal?
Yes
No
What equipment do you have available for snow removal?
If you are interested in being Sidewalk Worker, do you have a truck that can carry a snow blower and salt bags?
Yes
No
Not applying to be a sidewalk worker
In order to work for Pro Kleen Carpet Solutions you must supply a copy of your MVR (Motor Vehicle Record). Can you do this?
Yes
No
What programs do you have experience with?
Microsoft Word
Microsoft Excel
Microsoft Power Point
Microsoft Outlook
Microsoft Access
QuickBooks
Other
If you have experience with other software please specify.
Do you have a driver's license?
*
Yes
No
Have you ever been convicted of a felony?
*
Yes
No
The year you were released from Prison?
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
If you have been convicted of a felony please explain.
Are you on probation now?
Yes
No
If you are on probation now please explain.
Are you able to pass a drug test?
*
Yes
No
Current Employer
List Former Employers
*
Previous Employer name
Position
Street Address
City
State
Phone
Supervisor
Pay
Reason for Leaving
Please list last three employers
What is your highest level of education?
*
Some High School
Graduated High School/GED
Some College
Associate's Degree
Bachelor's Degree
Master's Degree
How did you find Pro Kleen Carpet Solutions?
Indeed
Zip Recruiter
Job Fair
Employee Reference
Other
If employee reference, who referred you to Pro Kleen Carpet Solutions? Or if other, please specify.
Agree to terms and conditions
*
As an applicant, and/or if I am employed by Pro Kleen Carpet Solutions I have read, understand, and specifically agree to abide by all of these rules and procedures at all times during my employment and/or association at Pro Kleen Carpet Solutions.
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