Employment Application

Thank you for taking the time to complete our online employment application. Please fill out the application below as completely as possible and paste your resume in the space below. This application will take approximately 15 minutes to complete.
* = Required Field
Personal Information
Last Name: *
First Name: *
Middle Name:
Nick Name / Preferred Name
Current Address:*
City:*
State / Zip Code:*   
Home Phone (Include Area Code): *    - 
Cell Phone (Include Area Code):    - 
E-Mail Address:*
Resume
Resume - If you have a plain-text resume, paste it into this box.
Availability
Are you currently under contract with another staffing firm? Yes    No
Do you currently have a non-compete agreement? Yes    No
Are you willing to work long term temporary? Yes    No
Are you willing to work temporary to hire? Yes    No
Are you looking for a full-time career position? Yes    No
When are you available to start?
What weekday hours are you available?
What weekend hours are you available?
Are you willing to work overtime? Yes    No
What is the minimum pay you desire? Hourly rate or annual salary
How much notice will you need if a position is offered to you?
How many miles are you willing to travel to a position?
Lifting Restrictions?
Where do you want to work?
Education
Enter most recent
Name of School:
Type of school:
Street Address:
City:
State / ZIP Code:   
Degree:
Major Study Area:
Other Studies:
Professional License / Certifications
Professional Licenses/Certifications:
Has Your Professional License Ever Been Under Investigation?
Are your 18 Years of Age or Older?
Software Proficiency Top 3
Employment History
List Your Previous Employers, Starting with the Most Recent:
Employer # 1
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Job Duties:
Start Date (Month / Year):
End Date (Month / Year):
Start Wage: Hourly rate or annual salary
End Wage: Hourly rate or annual salary
Reason For Leaving:
May we contact this employer for a reference check? Yes    No
Employer # 2
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Job Duties:
Start Date (Month / Year):
End Date (Month / Year):
Start Wage: Hourly rate or annual salary
End Wage: Hourly rate or annual salary
Reason For Leaving:
May we contact this employer for a reference check? Yes    No
Employer # 3
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Job Duties:
Start Date (Month / Year):
End Date (Month / Year):
Start Wage: Hourly rate or annual salary
End Wage: Hourly rate or annual salary
Reason For Leaving:
May we contact this employer for a reference check? Yes    No
Employer # 4
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Job Duties:
Start Date (Month / Year):
End Date (Month / Year):
Start Wage: Hourly rate or annual salary
End Wage: Hourly rate or annual salary
Reason For Leaving:
May we contact this employer for a reference check? Yes    No
Employer # 5
Company Name:
Street Address:
City:
State / ZIP Code:   
Supervisor Name:
Job Title:
Job Duties:
Start Date (Month / Year):
End Date (Month / Year):
Start Wage: Hourly rate or annual salary
End Wage: Hourly rate or annual salary
Reason For Leaving:
May we contact this employer for a reference check? Yes    No
 
CONDITIONAL OFFER EMPLOYMENT
I certify that the statements I have made are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.

When I am employed I agree that if at any time I make claims for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of employer's selection, at employer's expense, as often as may be requested.

I also agree that if I am employed, now or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination.

I am aware that Public Law 91-508, known as the Fair Credit Reporting Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information as to the nature and scope of the inquiry or any report which is produced.

I understand that the completion of the this application process shall constitute a conditional offer of employment subject to my availability and the availability of customer assignments calling for the skill and qualifications that I possess, and I agree to consider acceptance of such assignments and/or offer of permanent employment.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.

Initials:
      

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.