Employment
 
First Name*
 Middle Initial
 Last Name*
Street Address*
 City*
 State,   ZIP*
,
Phone Number*
 Other Phone Number
 Email
Resume: (copy and paste)*
Availability
 
What type of position?

 When are you available to start?
Are you willing to work temporary?
Yes No 		Are you willing to work overtime?*
Yes No
What weekday hours are you available:
 What weekend hours are you available:
How many hours are you willing to work in a week?*
 What is the minimum pay you desire?*
How much notice do you need if a position is offered to you?
 How many miles are you willing to travel to a position?
What type of work are you seeking and qualified for?
Education
 
Name of school:
 School Street Address
Type of school:
 City
 State,   ZIP
,
Date Started:
 Date ended:
 Degree:
 Major Study Area:
Employment History
 
Employer #1
Company Name
 Phone
Street Address
 City
 State,   ZIP
,
Supervisor
 Job Title
 Job Duties
Start Date     End Date
- 		Start Salary   End Salary
-

Employer #2
Company Name
 Phone
Street Address
 City
 State,   ZIP
,
Supervisor
 Job Title
 Job Duties
Start Date     End Date
- 		Start Salary   End Salary
-

Employer #3
Company Name
 Phone
Street Address
 City
 State,   ZIP
,
Supervisor
 Job Title
 Job Duties
Start Date     End Date
- 		Start Salary   End Salary
-
Submit Application
 

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 understand the term of my employment shall be limited to the duration of any assignment that I accept.

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 I am applying for temporary or contract assignments. 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.

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.
Initial*
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.