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Job Application
Please complete the form below to apply with us.
Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shifts Open To Working
Any Shift
First Shift
Second Shift
Third Shift
Open To
Full-Time
Part-Time
Applying For
Assembler
Machine Op
Warehouse
Office/Admin
Sales/Marketing
Cook/Dishwasher
Housekeeping
Packer
Supervisor/Manager
Other
Tentative Start Date
-
Month
-
Day
Year
Date
Pay Preference
Emergency Contact
*
Please enter a secondary phone number.
Type a question
*
YES
NO
Are you over the age of 18
If hired, do you have transportation to/from work
Are you able to stand for an eight to twelve-hour shift, either with / without reasonable accommodation
Are you able to lift up to forty (40) pounds repeatedly, either with / without reasonable accommodation
Are you currently taking any medication which may affect your ability to pass a controlled substance test
Do you have any chronic conditions or past health issues that could impact your work ability?
Choose if you are allergic or have/had any allergies related to any of the following.
*
Yes
No
Dust Mite
Plastic
Chemical
Latex
Asthma
Temperature, Humidity
Other
If Answered Yes To Other Allergy Please Name,
Please Select Skills you are experienced in
*
SKILLED In
Machine Operator
Assembly Worker
Shipping & Receiving
Forklift Operation
Quality Inspection
Soldering/Electronic Assembly
Supervisor/Management
CNC Operation
Setup Tech or Mold Tech
General Maintenance/Janitorial
Machine Maintenance
Housekeeping
Cooking / Sous Chef
Dishwashing
Quick Books
Account Management
Customer Service
Management Role
Sales/Marketing
Recruiting/Staffing
Medical Receptionist
Property Management
Attorney/Legal
Work History
Start with your most recent job, going backwards
How many jobs have you worked
1
2
3
4
5+
Most Recent Job
Please provide details about your most recent job
Company Name (1)
*
Job Title (1)
*
Start Date (1)
*
-
Month
-
Day
Year
Date
End Date (1) (If you are no longer working here)
-
Month
-
Day
Year
Date
Reason for Leaving (1)
*
(2) Second Most Recent Job
Please provide details about your second most recent job
Company Name (2)
*
Job Title (2)
*
Start Date (2)
*
-
Month
-
Day
Year
Date
End Date (2)
*
-
Month
-
Day
Year
Date
Reason for Leaving (2)
*
(3) Third Most Recent Job
Please provide details about your third most recent job
Company Name (3)
*
Job Title (3)
*
Start Date (3)
*
-
Month
-
Day
Year
Date
End Date (3)
*
-
Month
-
Day
Year
Date
Reason for Leaving (3)
*
(4) Fourth Most Recent Job
Please provide details about your fourth most recent job
Company Name (4)
*
Job Title (4)
*
Start Date (4)
*
-
Month
-
Day
Year
Date
End Date (4)
*
-
Month
-
Day
Year
Date
Reason for Leaving (4)
*
Upload photo of your Driver's License/State ID (use this if you are not able to take a picture in the previous step)
Browse Files
Drag and drop files here
Choose a file
Cancel
of
(5) Fifth Most Recent Job
Please provide details about your fifth most recent job
Today's Date
-
Month
-
Day
Year
Company Name (5)
*
Job Title (5)
*
Start Date (5)
*
-
Month
-
Day
Year
Date
End Date (5)
*
-
Month
-
Day
Year
Date
Reason for Leaving (5)
*
Take Photo of your current ID (Driver's License/State ID)
*
Upload Resume
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Can be contacted by SMS?
YES
NO
How did you find us?
*
Facebook / Instagram
Indeed
A+Staffing Team
Referral
Other
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