Employee Application

At Grace Home Cleaning we love our employees! Be ready to earn Top Dollar, after the first week of training employees can earn $16-$18 an hour with us. That is why we ensure that all of our employees meet the following pre-employment requirements,

  1. Good work history
  2. Must be able to work full-time Monday-Friday 8am-5pm
  3. Clean driving record
  4. Reliable transportation
  5. Must be able to pass criminal background check and a pre-employment drug screening.
We are committed to a policy of Equal Employment Opportunity and will not discriminate on any legally protected basis, including, but not limited to, race, age, color, religion, sex, national origin, citizenship, ancestry, physical or mental disability, veteran status, or any other legally protected basis.

Personal Background


Zip (required)



Previous (if less than 5 years at present address)


Contact Information

Drivers License

Employment Verification

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

Available Hours
What hours are you available to work on the following weekdays?






Which of the following categories of jobs have you had?

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.

Previous Job #1

Previous Job #2

Previous Job #3

Educational Background

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 of hiring.

Personal References
List the names of three persons not related to you, whom you have known at least three years.

Person Number 1


Person Number 2


Person Number 3


To what extent would the following job characteristics be attrictive to you?



I, the undersigned, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements will be considered as cause for possible dismissal.

I authorize Grace Professional Cleaners LLC, and any security agency service working for them, to disclose orally and in writing the results of this verification process and/or interview to the designated authorized representative of this company.

I have read and understand this release and consent, and authorize the background verification. I authorize persons, schools, current and former employers, personal references and other organizations and Agencies to provide Grace Professional Cleaners with all information that may be requested, and to conduct a verification, as deemed necessary by this Company to fulfill the job requirements, with regards to my motor vehicle records, credit history as allowed by EEOC and ECOA, and to receive any criminal history record information pertaining to me which may be in the files of any Federal, State or Local criminal justice agency in Nebraska or any other States. I hereby release all the persons and Agencies providing such information from any and all claims and damages connected with their release of any requested information. I agree that any copy of this document is as valid as the original. All results will be proprietary and will be kept CONFIDENTIAL and disclosed orally and in writing only to the designated authorized representatives of this Company and its Clients.

I do hereby agree to forever release, discharge and indemnify Grace Professional Cleaners and their associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting of information.


Please provide name, location and date of the school(s) attended: