Mr. Maid Application for Employment

Date: __________

We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally recongnized basis, including, but not limited to, race, age, color, religion, sex, marital status, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

Personal Background

Last Name: _______________________________ MI:_______ First Name:_______________________________

Present
Address: _________________________________ City: _____________________ State:______ Zip: __________

Permanent
Address: _________________________________ City: _____________________ State:______ Zip: __________

Telephone                                Person to Contact in                                                  Contact
Number: ________________ Case of Emergency: _________________________ Phone # __________________

Social Security # _________________________   Driver's License # ____________________________________

                                                                                   State Issued: __________________

                                                                                                                                                                    Office Use Only

Driving is a requirement of the job.  Is your license valid?                        ___ Yes    ___ No        1

Do you have full time access to a vehicle?                                                    ___ Yes    ___ No        2

Is your vehicle in good working condition?                                                 ___ Yes    ___ No        3

Is the vehicle covered by comprehensive liabiltiy insurance?                    ___ Yes    ___ No       4

What Company? ___________________________________

Policy Number: ___________________________________

Make of Vehicle: __________________ Model: _______________ Year: _____                           5 

Are you able, at the time of employment, to submit
verification of your legal right to work in the U. S.?                                   ___ Yes    ___ No       6

**Verification and completion of the I-9 form must be submitted no later than 3 business
days after hire.

Are you able to lift 50 pounds or more?                                                        ___ Yes   ___ No       7

Would you have difficulty standing, bending, or kneeling
in connection with performing necessary cleaning duties?                         ___ Yes   ___ No       8

Mr. Maid Application for Employment - continued: Page 2                                           Office Use Only

What hours are you available to work on the following week days?

  MONDAY           TUESDAY         WEDNESDAY          THURSDAY            FRIDAY
____ to ____          ____ to ____          ____ to ____           ____ to ____           ____ to ____           9

If hired, when can you start work?___________________________________________                  10

Are you presently employed?                                                                           ___ Yes  ___ No
                                                                                                                                                                   11
If "yes" may we contact your present employer?                                           ___Yes  ___ No  

Which of the following categories of jobs have you had?

___ House Cleaning                         ___ Hotel / Motel                           ___ Restaurant                      12

___ Fast Food                                   ___ Janitioral                                ___ Sales

___ Homemaker                               ___ Manufacturing                      ___ Services

___ Other (explain) ___________________________________

WORK EXPERIENCE
List below your last three employers, starting with your present or last place of employment.
You may include in such history any verified work performed on a volunteer basis.

Mr. Maid Application for Employment - continued: Page 3                                          Office Use Only

Have you ever been convicted of a criminal offense?
                                                                                                                                   ___Yes  ___No       19
If yes, explain:_____________________________________________                                                       

Have you ever been bonded?                                                                                  ___Yes  ___No       20

Has your driver's license ever been suspended?
                                                                                                                                   ___Yes ___No        21
If yes, explain:_____________________________________________               

Note:  Due to the security sensitive nature of the job, all employees are required to be bonded.
As a matter of policy, the company conducts a police background and driving record check
on any applicant in consideration for hiring.

PERSONAL REFERENCES
List the names of three persons not related to you whom you have known for at least three years.

Mr. Maid Application for Employment - continued: Page 4

PLEASE READ THE  FOLLOWING  STATEMENTS CAREFULLY  BEFORE  SIGNING  THIS  APPLICATION.   ONLY  THOSE  APPLICATIONS WHICH
ARE   SIGNED AND   DATED   ARE  CONSIDERED  VALID.   IF YOU HAVE
ANY QUESTIONS  REGARDING THIS STATEMENT,   PLEASE ASK THEM
BEFORE SIGNING.

Applicant's Statement

In signing this application, I certify that all of the foregoing information is a complete and  accurate statement
of the  facts and  understand that  if  any  misrepresentation,  omission  or  falsification  be  discovered,  it will
constitute grounds for dismissal.   I hereby  authorize the  company,  to which  I am  applying,  to conduct  any
investigation necessary concerning any part of my background related to the position I am  seeking, including,
but not  limited to,  the  obtaining of  a police  report  and  driving record.  I  authorize  any  of  the persons or
organizations  named  in  this  application  to   provide   complete   information   and   records  regarding   my
employment,  education,  character  and  qualifications.   I release all  parties from any liability  in connection
with the provision an use of such information.
                                                                                           [       ] YES       [       ]  NO

I understand and  agree that,  if  employed by  Mr. Maid Residential Cleaning Service,  I will be responsible for
familiarizing myself with all rules and regulations of the company as they presently exist or are later modified
and that I will abide by its rules and regulations which I understand are subject to change.
                                                                                           [       ] YES       [       ]  NO

I also understand  that  no representative  of the  company  has  any  authority  to  enter into  any employment
agreement  for any specified  period  of time,   or to  assure me  of  any  future positon,  benefits,  or terms and
conditions of employment.   I further understand that,  if hired,  my meployment  is  for  no  definite period of
time and may be terminated by either party at any time.
                                                                                           [       ] YES       [       ]  NO

I have read, understand and agree with the above.

                                   __________________________________________
                                   Applicant's Signature

                                   __________________________________________
                                   Date

This  application is current  for only 60  days  from  the  date  above  signed.    At the  conclusion  of  this   time,
if you have not heard from the employer and still wish to be considered for employment, it will be necessary to
fill out a new application.