Name
Last Name
First Name
Middle Initial
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
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Format: (000) 000-0000.
Alternate Phone Number
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Format: (000) 000-0000.
Position Desired
Minimum (Hourly) Pay Desired
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Employment
Name of Employer
Your Position
Date Hired
Date Left
Reason For Leaving
Employment
Name of Employer
Your Position
Date Hired
Date Left
Reason For Leaving
Employment
Name of Employer
Your Position
Date Hired
Date Left
Reason For Leaving
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Are you at least 18 years or older?
No
Yes
Are you either a U.S. Citizen or do you currently have unrestricted authorization to work for any employer in the U.S.?
No
Yes
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Work Type
Full-Time
Part-Time
Seasonal
Work Type
1st Shift
2nd Shift
3rd Shift
Safety Equipment That You Can Provide
Work Boots / Shoes Steel Toe
Hard Hat
Safety Glasses
Tools
General
Assembly
Brake Press
Carpenter
Cleaning
CNC Operator
Concrete
Construction
Electrical
Injection Molding
Inventory
Janitorial
Labor
Laundry
Landscape
Lawncare
Machinist
Mail Room
Maintenance
Machine Operator
Mechanic
Mover
Packaging
Painter
Plumber
Printer
Quality Control
Road Construction
supervisor
Welder
General
Computer Skills
Load / Unload
Hand Scanner
Order Selector
Receiving
Shipping
Electric Pallet Jack
Manual Pallet Jack
General
Sit Down Forklift
Stand Up Forklift
Clamp Forklift
Forklift Attachments
Crane
End Loader
Skid Loader
General
Administrative Assistant
Customer Service
Excel
Fax
Receptionist
Telemarketing
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Have you ever been convicted of or have you pleaded guilty to a felony or misdemeanor (exclude minor traffic offenses or convictions which have been sealed or expunged)?
No
Yes
If Yes please explain
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Read each of the statements carefully and affirm that you understand and consent to them by signing at the bottom of the page. Please date your signature.False Application False answers or omissions to questions or false statements or omissions made on this application, during interviews or in your resume, or in supplement thereto, including, but not limited to, with respect to duties, responsibilities, job title or salary and bonus information, may invalidate your application or, if you are hired, may be grounds for discharge from employment.Employment is “At Will” Employment at Iowa Staffing is for an indefinite and unspecified duration. If you are hired, you may leave employment at will, and the Company may discharge you or any or all other employees at any time, without notice, and for any reason not prohibited by law. The preceding sentence may not be changed or superseded by any oral or written statement, Company manual, policy, or benefit plan, and may only be changed or superseded by: 1.) A special written agreement specifying in detail the duration and terms of your employment, which has been executed by you and an executive corporate officer of Iowa Staffing or 2.) A written, formal restatement of the employment relationship by the President of the Company. The Company disavows any oral or any other written statements to the contrary, and you should not now or in the future rely on any such statements with respect to your employment.Handbooks, Manuals, Policies, Procedures, Benefits, Etc. The Company may, at its sole discretion, hold in abeyance or revoke, amend or modify, abridge or change any benefit, policy, procedure, practice, condition, or process affecting employees. Descriptions of these that may be contained in any handbook, manual, policy, and the like are for informational purposes and are not intended to be, nor should they be construed to constitute, an employment contract, an offer of initial or continuing employment, or a promise or a guarantee made by the Company.Immigration Reform and Control Act (IRCA) This federal law prohibits the employment of unauthorized aliens and further requires that, if you are hired, Iowa Staffing verify your identity and your authority to work in the United States on a Form I-9, even if you are a U.S. citizen. This must be done within three days from when you begin employment. You are responsible for obtaining and providing the documentation required to perform the verification. Failure to provide required information will result in termination of employment. [Information concerning the verification procedure and requirements is available upon request.]Medical/Substance Abuse Testing In applying for and during employment, you agree to voluntarily participate and cooperate, if so requested by the Company and as not prohibited by applicable law, in 1.) blood, urine, or other forms of testing to determine the presence of controlled drugs, illegal substances, or alcohol, and 2.) post-offer medical physical examinations. Such tests or examinations will be performed by the Company, and you hereby authorize them to release the results of these tests or exams to Iowa Staffing.Applicant Acknowledgement
Authorization I voluntarily give Iowa Staffing or its authorized agent the right to make any investigation of my background deemed necessary by them including, but not limited to, my present and former employment, my educational background, and my personal or professional references; and I hereby authorize those persons or institutions contacted by Iowa Staffing or its agents to provide the information requested, including the reasons for termination of my employment, work performance, and other information pertinent to my qualifications for employment. Any offer of employment is contingent upon the successful completion of the Company’s total pre-employment screening process.
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