Employment Application Form

Name:*

First NameLast Name
Birth Date*

MonthDayYear
E-mail Address:*
example@example.com
Phone Number:*

Area CodePhone Number
Full Social *
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How were you referred to us?*

Walk-InEmployeeFacebookLinked InCraigslistWebsiteSearch EngineOther

In which area would you like to work?*
Have you ever applied to / worked for Leverage Staffing Inc. before?*

YesNo
If hired, would you have transportation to/from work?*

YesNoOther
Have you been convicted of or pleaded no contest to a felony within the last five years?*

YesNo
If yes, please describe the crime - state the nature of the crime(s), when and where convicted, and the disposition (final settlement) of the case:
If hired, are you willing to submit to a controlled substance test?*

YesNo

References

Please list two (2) references that are familiar with your work life.
Reference 1
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years known *
Reference 2
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years known *

When are you available for an interview if you were to receive one?*
Authorization to Release Information

I hereby authorize any person, company, and or educational institution I have listed as a reference on my employment application to fully disclose in good faith any information they may have regarding my qualifications for employment. I will not hold any prospective or former employer, educational institutions, and nor any other persons giving references liable for the exchange of this information along with any other reasonable and necessary information that is necessary and inherent to the employment process.
Signature

Clear
Date*

MonthDayYear
Date
Should be Empty: