Employment Application
Application Information
Date:
*
-
Month
-
Day
Year
Date
Name:
*
First Name
Middle Name
Last Name
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email:
example@example.com
Date Available:
-
Month
-
Day
Year
Date
Social Security Number:
Desired Salary ($):
Position Applying for:
Have you ever worked for Staffing Specialists?:
Please Select
Yes
No
If yes, when:
-
Month
-
Day
Year
Date
Have you ever been convicted of a felony?:
Please Select
Yes
No
If yes, explain:
Education
High School Name:
Did you graduate?:
Please Select
Yes
No
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
College Name:
Did you graduate?:
Please Select
Yes
No
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Degree:
Previous Employment
Company:
Phone Number:
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor:
Job Title:
Starting Salary ($):
Ending Salary ($):
Responsibilities:
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?:
Please Select
Yes
No
Company:
Phone Number:
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor:
Job Title:
Starting Salary ($):
Ending Salary ($):
Responsibilities:
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?:
Please Select
Yes
No
Company:
Phone Number:
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor:
Job Title:
Starting Salary ($):
Ending Salary ($):
Responsibilities:
From:
-
Month
-
Day
Year
Date
To:
-
Month
-
Day
Year
Date
Reason for Leaving:
May we contact your previous supervisor for a reference?:
Please Select
Yes
No
Office Typing (if applying)
Years of experience:
Words Per Minute:
Emergency Contact
Full Name:
First Name
Last Name
Relationship:
Phone Number:
Please enter a valid phone number.
References
Please list two professional references
Full Name:
First Name
Last Name
Relationship:
Company:
Phone Number:
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Full Name:
First Name
Last Name
Relationship:
Company:
Phone Number:
Please enter a valid phone number.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that I am applying for work and I authorize Staffing Specialists to check my reference. I agree to contact Staffing Specialists after each assignment is completed. I agree that I am an employee of Staffing Specialists and if I obtain permanent employment with the company where I am placed. I agree to pay recovery changes. I also agree that if I abandon an assignment, my salary will be dropped to minimum wage.
Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: