Eastern Personnel Employee Application Online

Eastern Personnel Services

619 Central Ave.

Cincinnati, OH 45202

info@easternhires.com

www.easternhires.com

(513) 421-4666
Employment Application
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Second Phone Number
Email*
example@example.com
Social Security Number*
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relation
Highest Level of Education Completed:*
Mode of Transportation*
How did you hear about us?
Have You Ever Been Convicted of a Felony?*
If so, What year (s)?
Type of Conviction (If none, write N/A):*
I agree that I have been informed of the requirements of the work for which I am applying and that the information on this application is correct and complete to the best of my knowledge. I understand that It shall be grounds for immediate dismissal if any of the information contained herein is found to be untrue. I authorize you and all former employers that have been given by me as references to answer all questions and to give all information in connection with this application or in any way concerning me. I understand that if accepted for employment, I will be working for you on your payroll at your or your client's premises. I agree that I will obtain your permission before discussing permanent employment with your client. I agree to immediately notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice, you may assume that I am either not ready, unwilling, or unable to work. I understand that any information I learn while working for a client is to be kept confidential. I agree if employed by you, that if I ever make claims against you for personal injuries, upon your request I shall submit to an examination by physicians of your selection. I will hold you harmless from any claims, including but not limited to personal injury or illness, due to my providing false or misleading information on this application. I hereby acknowledge that my employment is "at will" and that I may resign at any time and the company may terminate my employment at any time with or without cause.

AFTER READING AND UNDERSTANDING, PLEASE INITIAL HERE: Initial*

I verify that I am not using drugs and understand certain positions require a drug screening, which I must pay for out of my paycheck.   Initial*  I agree to random drug screenings if required.Initial*  I understand if Eastern or a client provides me with equipment, uniforms, keys, or a badge that I fail to return, I agree to have the cost of those items deducted from my paycheck.   Initial*I understand if I lose my check or if I request my check to be mailed, and it is lost or stolen, Eastern can stop the payment and re-issue the check providing the cost is deducted from my re-issued check.Initial*   I understand unless I have Eastern's written authorization, I agree not to work or apply for work for at least one year at any of the client companies where Eastern sent me to work. If I do so, I will agree to become financially liable for the fee of 20 percent of my annualized salary.   Initial*      I agree to immediately notify Eastern if any work-related injury occurs during my employment.

I fully understand that my initials above and my signature below certify that I have read, understand and agree to the information written above.

Signature *   Date

Interviewed by: Interviewer Name
Employment Desired:
Employment Type*
Position Type*
Date You Can Start*

MonthDayYear
Date
Position Applying For*
Have You applied here before?*

YesNo
Skills/Qualifications:
Skills
List any relevant skills
Qualifications
List any relevant certifications or qualifications
Current Employment:
Current Employer
Name of Current Employer or NONE if not Employed
Position
Current Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
May We Contact?

YesNo
Job Duties:
Previous Employment:
Previous Employer*
Name of Previous Employer
Position*
Previous Salary ($)*
Reason for Leaving?*
Start Date*

MonthDayYear
Date
End Date*

MonthDayYear
Date
Job Duties:*
Previous Employer
Name of Previous Employer
Position
Previous Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Job Duties:
Additional Information
Community Involvement:
What are the top three things that are important for your employer to know?
Employment References
Company Name 1*
Supervisor*
Supervisor Phone*
Supervisor Email
example@example.com
Company Name 2
Supervisor
Supervisor Phone
Supervisor Email
example@example.com
Company Name 3
Supervisor
Supervisor Phone
Supervisor Email
example@example.com
Character References:
Reference 1*
Name of Reference
Relationship*
Years Acquainted*
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone Number
Please enter a valid phone number.
Email
example@example.com
Reference 3
Name of Reference
Relationship
Years Acquainted
Email
example@example.com
Phone Number
Please enter a valid phone number.
Education
High School*
Did you graduate?*
Year of Graduation

MonthDayYear
Date
College
Degree
Date

MonthDayYear
Date
Other
Degree/Certification
Date

MonthDayYear
Date
I grant my permission to fully check any and all of my references

First Name* Last Name* Signature * Date*
I acknowledge that if I stop going to work, I will not receive compensation from Eastern Personnel.

I understand I can be terminated without warning due to tardiness, absenteeism, loafing, or disrespect.

I understand that if I violate any company policies, Eastern will deny my request for Unemployment Benefits.

First Name* Last Name* Signature * Date*
Cover Letter, Resume (Optional):
Cover Letter

Cancelof
Resume

Cancelof

Valid Identification:
Please Upload Two Forms of Valid ID (Examples: Driver's License, ID Card, Passport, Birth Certificate, Social Security Card)
Please Upload Two Forms of Valid ID (Examples: Driver's License, ID Card, Passport, Birth Certificate, Social Security Card). Make sure to show entire document.

Eastern Personnel Services Employee Agreement

IMPORTANT: PLEASE READ IN FULL AND INITIAL BELOW
InitialIf a client requires an FBI/BCI check, I must successfully pass an FBI/BCI check to continue my employment. I also understand the cost to process an FBI/BCI Check is $75.00, and it will be absorbed by Eastern Personnel in advance and automatically deducted from the first paycheck I receive from Eastern Personnel unless I make other arrangements with the Payroll Department of Eastern Personnel.

Initial   If a client requires a Drug Screening, I must successfully pass the Initial Drug Test before being assigned to a client. I also understand that the cost to process the initial Drug Test is $30 and will be absorbed by Eastern Personnel in advance and automatically deducted from the first paycheck I receive from Eastern.

Initial   If I am assigned any keys, equipment, uniform, etc. by a client I understand I must return it in the condition that it was received, or the dollar value will be automatically deducted from my check.

Initial   If the Client audits Eastern Personnel Services, I give Eastern permission to release the results of all FBI/BCI and Drug screening results to the Client.

Initial   I agree to keep in confidence all information relating to the products, product plans, methods of operations, trade secrets, customers and markets of assigned Client/Eastern, business plans, business opportunities, finances, know-how or personnel data, and all other confidential knowledge, data, and information related to the business and affairs of assigned Client/Eastern that may be acquired pursuant to or in connection with my assignment or the relationship contemplated by this assignment.

Initial   I understand if I do not sign in and out while at work, (even if there is a time clock) I will not get paid and will no longer be offered any assignments through Eastern Personnel. I understand I must have either a bank account of my own, sign up with US Bank or Kemba Credit Union or sign up for a Rapid Pay Card in order to receive my pay.

Initial   I hereby grant to Eastern Personnel Services inc., or any of its agents, the right and permission, in respect of the photographs and video which Eastern Personnel Services or its agents have taken of me, or which may be included with others1 to copyright the same in its name or otherwise; to use, reuse, publish and re-publish in the same in whole or in part, in conjunction with any printed
matter in any media now or hereafter known, and for any purpose whatsoever.,
for illustration, promotion, art, advertising, trade, or any other purpose;
and to use my name, and any statement made by me, in connection in addition to
that if Eastern Personnel Services or any of its agents so chooses.

I fully understand that my initials above and my signature below certifies that I have read, understand, and agree to the information written above.

Signature *       Date*

Witness

Send Application
By clicking the submit button below, I cerity that all of the information provided by me on this application is true and complete, and I understand that if any false information, ommissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employement may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compenstation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
Date

MonthDayYear
Date
Signature*

Clear
Voluntary Disclosure Form

Please fill out our Voluntary Self-Disclosure Form. The link will be displayed on the “Thank You” page after submission of the Application. Please note that the submission of personal information is entirely voluntary. We guarantee that any information provided will be kept confidential and will be used solely for record keeping and compliance reporting purposes as required by applicable laws. Refusal to provide such information will not result in any adverse consequences or affect your application for employment with our company in any way.
Voluntary Disclosure Form
Should be Empty:

Employment Application

Personal Information:

Employment Desired:

Skills/Qualifications:

Current Employment:

Previous Employment:

Additional Information

Employment References

Character References:

Education

I grant my permission to fully check any and all of my references

Cover Letter, Resume (Optional):

Valid Identification:

Eastern Personnel Services Employee Agreement

Send Application

Voluntary Disclosure Form