Contractor Employee Application - Elite Environmental Cleaning Services

INDEPENDENT CONTRACTOR EMPLOYEE APPLICATION

General Information

Name:

First

Middle

Last

Address:

Address Line 1

City

State / Province / Region

Postal Code

Country

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Home Phone:

Email:

Other Telephone:

Are you legally authorized to work in the United States?

Yes
No

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Date of Birth:

Social Security #:

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Florida Driver License / ID#:

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Expiration Date:

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Other Form of Identification / Immigration Identification:

Click or drag a file to this area to upload.

Expiration Date:

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Emergency contact:

Phone:

Relationship:

Previous Employment

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Previous Employer:

Supervisor Name:

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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Email

Can we contact your previous employer?

Yes
No

If no, why?

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Employed from:

End of employment:

Reason for leaving:

Have you ever filed for workers comp?

Yes
No

Have you ever filed a lawsuit or complaint against an employer?

Yes
No

Have you ever filed a claim for a slip & fall or work-related injury?

Yes
No

I certify that the information contained in this Independent Contractor Application is true and correct and complete. I understand that if I am contracted, any false statements can be considered sufficient cause for termination.

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Signature of Independent Contractor employee:

Click or drag a file to this area to upload.

Date

+ 954-280-8402

4474 Weston rd #1151 ,USA

Monday / Sunday : 24/7

INDEPENDENT CONTRACTOR EMPLOYEE APPLICATION

General Information

Previous Employment

4474 Weston rd #1151

+ 954-280-8402

Eecs@eliteecsusa.com

# 305 417 5423