Cleaner Application Form Title(required) – Mr Mrs Miss Ms Other First Name(s)(required) Surname(required) Address (line 1)(required) Address (line 2)(required) Post Code(required) Email(required) Phone Number(required) Date of Birth (Date/Month/Year)(required) NI Number(required) Nationality(required) Are you eligible to work in the uk?(required) Yes No Are you happy to work on a self employed basis?(required) Yes No Do you give permission for a DBS Check (Police Check) ?(required) Yes No Do you have any criminal convictions or conditional cautions ?(required) Yes No If Yes Please give details Do you have children or other dependants ?(required) Yes No If yes, do you have someone else to care for them whilst you are working? (including school holidays?)(required) Yes No Not applicable What days are you available?(required) Monday Tuesday Wednesday Thursday Friday What times are you available? From?(required) – 7am 8am 9am 10am 11am 12 noon 1pm 2pm 3pm 4pm 5pm 6pm 7pm To?(required) – 7am 8am 9am 10am 11am 12 noon 1pm 2pm 3pm 4pm 5pm 6pm 7pm Do you have a Driving licence and your own transport?(required) Yes No How far are you willing to travel? (required) – 1 mile 2 miles 3 miles 4 miles 5 miles 6 miles 7 miles 8 miles 9 miles 10 miles Reference 1 Company Name(required) Title(required) – Mr Mrs Miss Ms Other First Name(s)(required) Surname(required) Address (line 1)(required) Address (line 2)(required) Post Code(required) Email(required) Phone Number(required) Reference 2 Company Name(required) Title(required) – Mr Mrs Miss Ms Other First Name(s)(required) Surname(required) Address (line 1)(required) Address (line 2)(required) Post Code(required) Email(required) Phone Number(required) Do you give permition for J Foster Ltd to contact both refences provided prior to the interview stage?(required) Yes No Please describe why you feel you are suitable for this role:(required) I agree that all information above is accurate and true. Send By submitting your information, you're giving us permission to email you or contacting you via telephone to discuss this position.
