P. GRAY STAFFING SOLUTIONS
General Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Job(s) Applied For:
Referral Source (Please check the appropriate category and list the source.)
Walk-in
Employee
Advertisement
Company’s Website
Online Posting/Other Internet
School
Job Fair
Staffing Agency
Government Employment Agency
Other
If necessary, best time to call you is:
Hour Minutes
AM
PM
AM/PM Option
May we contact you at work?
Please Select
Yes
No
N/A
If yes, work phone number:
If you are under 18 and it is required, can you furnish a work permit?
Please Select
Yes
No
If no, please explain:
Have you submitted an application here before?
Please Select
Yes
No
If yes, date:
Have you ever been employed here before?
Please Select
Yes
No
If yes, give dates (From/To):
Is this application a request for reemployment following an extended military leave of absence from this company?
Yes
No
Are you legally eligible for employment in this country?
Yes
No
Date available for work:
-
Month
-
Day
Year
Date
What is your desired pay? $___ Per___
Type of employment desired:
Full-Time
Part-Time
Temporary
Seasonal
Educational Co-Op/Internship
If they have been explained to you, are you able to meet the attendance requirements of the job?
Yes
No
N/A
Will you relocate if job requires it?
Please Select
Yes
No
Will you travel if job requires it?
Please Select
Yes
No
Will you work overtime if required?
Please Select
Yes
No
If no, please explain:
A valid driver’s license is required if driving is required in the job for which you are applying:
State:
Please Select
Have you ever been bonded?
Please Select
Yes
No
Are you able to perform the “essential functions” of the job for which you are applying (with or without reasonable accommodation)?
Yes
No
Need more information about the job’s “essential functions” to respond
Have you ever pleaded “guilty” or “no contest” to, or been convicted of, a misdemeanor or felony?
Yes
No
If yes, please provide date(s) and details:
Have you ever been arrested for any matters for which you are currently out on bail or on your own recognizance pending trial?
Yes
No
If yes, please provide date(s) and details:
Have you entered into an agreement (either written or verbal) with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?
Yes
No
If yes, please explain:
Have you entered into an agreement (either written or verbal) with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?
Yes
No
If yes, please explain:
Educational Background
Starting with your most recent school attended, provide the following information.
School (include City and State)
Years Completed
Completed
Diploma
GED
Degree
Certification/Other
GPA/Class Rank M
Major/Minor
Employment History
Starting with your most recent employer, provide the following information.
Employer Name
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Starting job title/final job title:
Submit
Should be Empty: