Peoria: 309-641-1100
Bloomington: 309-455-8044
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About Us
Carpet Cleaning
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Join Our Team
Name (or Company Name if Sub Contractor)
First
Last
Primary Phone Number
*
111-222-3333
Secondary Phone Number
111-222-3333
Email
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
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
List Former Employers (or) references if you are interested in being Sub-Contractor
*
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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