This company does not discriminate in the recruitment, hiring and conditions of employment on the basis of race, color, religion, national origin, sex, marital status, disability, age or veteran status. No question on this application is intended to secure information to be used in a discriminatory manner. Your completed application will be reviewed carefully, but its receipt does not imply that you will be employed. Employment consideration necessitates that you meet all minimum qualifications required on the positions for which you are applying.
Identification
Last Name:
First Name:
Middle Name:
SSN:
--
Present Address:
City:
State:
Zip Code:
Emergency Contact:
Emergency Telephone:
Other Names Used:
W-4:
Business Phone:
May We Call You:
Yes No
Resident Phone:
Message Phone:
Date Available To Start Work:
Minimum Salary:
Miscellaneous
Check The Weight You Can Handle:
Up To 25 lbs.
25-50 lbs.
51-100 lbs.
Over 100 lbs.
Are You Available To Work? (Check All That Apply)
Days
Monday
Nights
Tuesday
Full Time
Wednesday
Part Time Only
Thursday
Summer Only
Friday
Rotating Shifts
Saturday
Temporary
Sunday
Overtime
Describe any other training, foreign language ability/knowledge,
patents, publications, special recognition awards you consider
significant.
Foreign Language Skills
Level of Proficiency
Language
Speak
Read
Write
Language
Speak
Read
Write
Fair
Good
Excellent
Have you, within the last five years, been convicted of, or entered a plea of guilty to a criminal offense (including any conviction or quilty plea entered while in military service), or are you currently on defered adjudication? A "yes" may not necessarily disqualify you from consideration.
No Yes
If yes, explain fully:
Skills
Skills
Skills
Skills
Skills
IBM or Compatible
Windows
Word Perfect
Microsoft Works
Lotus
Quattro Pro
MRP
Peach Tree Accounting
Auto CAD
Harvard Graphics
Computer Programming
Multiline Phone System
Switchboard
Data Entry
10 Key (by touch)
File Clerk
Typing (WPM)
Receptionist
Transcriptionist
Wordprocessing
Payroll Clerk
Bookkeeping
Banking
Cashier
Fastfood
Restaurant
Waitress/Waiter
Cook
Housekeeping
Nurse Aide
Industrial Mechanic
Air Conditioning/Heat
Auto Detailer
Diesel Mechanic
Auto Mechanic
Industrial Sewing
Injection Molding
Welding
Mig
Tig
Stick
Certification
Inventory Clerk
Sand Blast
Grinder
Electrostatic Paint
Machine Operator
Punch Press
Drill Press
Shear Brake
Lathe Operator (Spec.)
Table Saw
Production
Assembly
Furniture Moving
Warehouse Work
Packing/Wrapping
Forklift Operator
Landscaping
Concrete Work
Carpentry/Painting
Plumbing
Electrical
Journeyman
Master
Drywall Hang/Finish
Maintenance
Janitorial
Security
Printing/Binding
Plastic Molding
Soldering
Truckdriving
CDL
CDL Type
Farm/Ranch
Shipping/Receiving
Dozier
Backhoe
Frontend Loader
Dump Truck
Draftsman
Blueprint
Fabricator
Management
Retail
Industrial
Food
Burner
Sheet Metal
CNC Punch
Accounts Rcv/Pay
WORK EXPERIENCE - Indicate all employment or other activity, including military and/or voluntary service, for at least the past ten years. Answer all questions.
Present Or Last Employment
Name of present or last employer:
Type of Business:
Address:
City:
State:
Date Started:
Date Left:
Starting Pay:
Final Pay:
Reason for leaving:
May we contact present employer:
Yes No
Job Title:
Name of supervisor - job title:
Company Phone Number:
Description of work and responsibilities:
Previous Employment
Employer:
Type of Business:
Address:
City:
State:
Date Started:
Date Left:
Starting Pay:
Final Pay:
Reason for leaving:
Job Title:
Name of supervisor - job title:
Company Phone Number:
Description of work and responsibilities:
Previous Employment
Employer:
Type of Business:
Address:
City:
State:
Date Started:
Date Left:
Starting Pay:
Final Pay:
Reason for leaving:
Job Title:
Name of supervisor - job title:
Company Phone Number:
Description of work and responsibilities:
Previous Employment
Employer:
Type of Business:
Address:
City:
State:
Date Started:
Date Left:
Starting Pay:
Final Pay:
Reason for leaving:
Job Title:
Name of supervisor - job title:
Company Phone Number:
Description of work and responsibilities:
Certification
Current Certifications:
Date:
Education
Name of School
City
State
Graduated?
Yes No
Specific Degree
Major field of study
Grade
Average
High School
Business or Trade School
College or University
College or University
Graduate Study
By submitting this form, you hereby acknowledge the following statements.
I understand and agree that:
Any material misstatement or deliberate omission of a relevant fact by me in this application, a resume, and/or attachments will be sufficient cause for termination consideration of my application or my subsequent employment.
Personnel Services may procure or have prepared an investigative/credit report to verify any information affecting my employment.
My employment with Personnel Services may be subject to satisfactory completion of a physical examination, which will include a drug screening test, conducted at the direction of Personnel Services prior to my employment or at such time as may by required by Personnel Services.
If I am employed by Personnel Services, my employment and compensation may be terminated at any time at the option of either Personnel Services or myself, with or without cause, and with or without notice.
If I am employed by Personnel Services, I will abide by Personnel Services policies and procedures.
Policy manuals, employee handbooks, and statements of employee benefits are informational only and do not create an employment contract or alter my status as an at-will employee and no employee or representative of Personnel Services, other than an officer of Personnel Services, has the authority to enter into any agreement which alters my status as an at-will employee.
I authorize the institutions and individuals listed on this application to give Personnel Services any and all information thay may have, personal or otherwise, concerning my previous employment, educational background, or personal character, and I release all parties from any liability that may result from furnishing such information to Personnel Services.
If United States Government security clearance is required after employment, I shall make application for same.
If my application for employment or my employment is subject to a local ordinance, state statute or law that supercedes any provision of this application form, then that ordinance, statute or law will apply.
