EmailMeForm
Independent Contractor Application
Name
*
First
Last
Best number to reach you
*
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Date of Birth
*
MM
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DD
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YYYY
Social Security Number
*
Add social security number without dashes
Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Job References
Please tell us your previous cleaning experience. If you do not have previous cleaning experience, please list your last two job expereinces.
1. Company Name
*
Date Worked To
*
MM
/
DD
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YYYY
Date Worked From
*
MM
/
DD
/
YYYY
Contact Phone Number
*
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2. Company Name
*
Date Worked From
*
MM
/
DD
/
YYYY
Date Worked To
*
MM
/
DD
/
YYYY
Contact Phone Number
*
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Signature & Agreement
*
By checking this box, I certify that my answers are true and correct. I also understand that my relationship with The Clean Up Club is that I am an independent contractor.
Today's Date
*
MM
/
DD
/
YYYY
Email
Please provide an email address above. This is how you will receive your 1099 at the end of the year. You will not receive a paper form in the mail.
Acknowledgement of Future Email Address Changes
*
By Checking this box, you acknowledge by providing this email address that you are responsible for updating your email address with us if you change it for any reason.
