Clean Source Employment Application
We are currently hiring for multiple positions with Clean Source Inc.

Please fill out the application below to be considered for employment on the Clean Source Inc. team!
Personal Information
First Name *
Your answer
Last Name *
Your answer
Are you 18 years or older? *
Address *
Your answer
City/State *
Your answer
Zip code *
Your answer
Primary Phone *
Your answer
How were you referred? *
Your answer
Employment Qualifications
Position Desired *
Have you previously worked in a cleaning environment? *
Select which area of cleaning you have experience in. *
Are you permitted to work in the U.S.? *
Have you been convicted or plead guilty to any crime? Do you have any pending charges against you? *
If yes, please explain
Your answer
Do you give Clean Source permission to run your criminal history report? (This is a requirement for employment) *
Will you consent to a controlled drug screening? (This is a requirement for employment) *
Work Experience
Please provide your last three employment experiences:

Include these items:
- Employer Name
- Job Title / Duties
- Dates of Employment
- Shift or Hours
- Wages Earned
- Reason for Leaving
- Employer Contact Information
Current Employment *
Your answer
Previous Employment *
Your answer
Previous Employment *
Your answer
Date You Can Start *
Please make sure all items are accurate and complete. I certify that all 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 or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. I understand that some facilities use video cameras for security. I also understand that I may be photographed or video taped while in these facilities and that these images are for security purposes only. Please type your full name if you agree.
Your answer
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