ASSIGN STAFFING -EMPLOYMENT APPLICATION

We are an Equal Opportunity Employer and is committed to excellence through diversity.

The application must be fully completed to be considered Please complete each section, even if you attach a resume.
Personal Information
Name

First NameLast Name
Mobile Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Street Address

Address

Street Address Line 2

CityState

Zip
Are you a US Citizen?
Have you ever been convicted of a felony?
If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test??

Education
1. School Name
1. School Location
1. Degree/Diploma/Certificate Received
1. Did you graduate?
1. Major/Subject?
2. School Name
2. School Location
2. Degree/Diploma/Certificate Received
2. Did you graduate?
2. Major/Subject?
f3. School Name
3. School Location
3. Degree/Diploma/Certificate Received
3. Did you graduate?
3. Major/Subject?

References

Please list 2 good references
1. Reference Name
1. Reference Email
example@example.com
1. Reference Title
1. Reference Company Association
What Company do you know this reference from?
1. Reference phone number
Please enter a valid phone number.Format: (000) 000-0000.
2. Reference Name
2. Reference Email
example@example.com
2. Reference Title
2. Reference Company Association
What Company do you know this reference from?
2. Reference phone number
Please enter a valid phone number.Format: (000) 000-0000.

Employment History
1. Employer Name (Most Recent)
1. Your job title
1. Dates employed
If presently employed type "mm/yy -present"
1. Work Phone number
Please enter a valid phone number.Format: (000) 000-0000.
1. Starting Pay
1. Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2. Employer Name
2. Your job title
2. Dates employed
If presently employed type "mm/yy -present"
2. Work Phone number
Please enter a valid phone number.Format: (000) 000-0000.
2. Starting Pay
2. Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Employer Name
3. Your job title
3. Dates employed
If presently employed type "mm/yy -present"
3. Work Phone number
Please enter a valid phone number.Format: (000) 000-0000.
3. Starting Pay
3. Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Employer Name
4. Your job title
4. Dates employed
If presently employed type "mm/yy -present"
4. Work Phone number
Please enter a valid phone number.Format: (000) 000-0000.
4. Starting Pay
4. Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
5. Employer Name
5. Your job title
5. Dates employed
If presently employed type "mm/yy -present"
5. Work Phone number
Please enter a valid phone number.Format: (000) 000-0000.
5. Starting Pay
5. Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Application Signature Disclaimer
I represent that the information provided in this employment application (and accompanying documents, if any) is true and complete. I understand that any false information or significant omissions may disqualify me from any further consideration for employment and may be justification for dismissal from employment if discovered at a later date. I agree to immediately notify Assign Staffing, LLC, if I should be convicted of any crime while my job application is pending.

I authorize investigation of all statements contained in this application and authorize any individual or entity to provide information and opinion to Assign Staffing as part of the investigation. I authorize Assign Staffing to disclose information contained in this application along with any information about me obtained through investigations or during the course of the interview process. I release Assign Staffing, LLC and any individual, or entity providing information to Assign Staffing, from any legal liability for any damages from the disclosure of this information. understand that if accused of wrongdoing while employed, I may be subject to probe by an outside agency. I understand and agree that, if I am hired, my employment is "at-will" which means that it is for no definite period of time and may be terminated by me or Assign Staffing at any time for any reason.

I understand that if am hired, Assign Staffing does not guarantee any specific number of hours or shifts, and I may or may not be assigned as determined by Assign Staffing. I understand and agree that I will not accept employment by any Assign Staffing client where I have been assigned by Assign Staffing for a period of six (6) months following termination of my employment with Assign Staffing. Iunderstand that if am hired, a client may decide not to utilize my services at any time and will inform Assign Staffing if this occurs. That decision is made solely by the client. I understand and acknowledge that if this occurs, I may, or may not be assigned to other clients. In the event I have any concerns regarding my assignment to a client, I will immediately bring my concerns to Assign Staffing's attention.

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.
Type your name here

First NameLast Name
Today's Date

MonthDayYear
Date
Signature
Upload Resume/Cover Letter/ Recommendation Letters here (option)

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Personal Information

Position

Shift Availability

Education

References

Employment History

Application Signature Disclaimer