This pre-screening questionnaire is for the benefit of Burns Cleaning to aid us in selecting interviewees. If selected for an interview, you will be asked to complete a more thorough employment application. Please fill in the application form below First Name * Last Name * Street/Mailing Address * Town/State/Zip Code * Email Address * Primary Phone * Alternate Phone How many hours are you available per week? * What hours of the day are you available? * Date you can start * Preference * Part Time Full Time Are you over 18? * Yes No Have you ever been convicted of a felony? * Yes No If yes, please explain: Personal Info Do you have a valid driver’s license? * Yes No Do you own a car? * Yes No Can you show proof of insurance? * Yes No Do you have references? * Yes No Legally able to work in the U.S.? * Yes No Do you speak fluent English? * Yes No Recent Employment History Most recent Job: Employer: * Employed When * Address: * Phone: * Job Title and Description * Recent Employment History 2nd Most recent Job: Employer: * Employed When * Address: * Phone: * Job Title and Description * Recent Employment History 3rd Most recent Job: Employer: * Employed When * Address: * Phone: * Job Title and Description * Are you a robot? If you are human, leave this field blank. Δ