EMPLOYMENT APPLICATION

EMPLOYMENT APPLICATION
Please complete the entire application PFL Services Inc policy to provide equal employment opportunities to all applicants and employees without regard to any legally protected status such as veteran status, uniformed service member status, race, color, religion, sex, national origin, age, physical or mental disability, genetic information or any other category protected by applicable federal, state, or local laws.
Personal Information
Full Name:*
Same as shown on your identification card.
Address:*
(Street # and Street Name)
Lot/Apt/Unit #
City*
State*
Zip Code*
Date of Birth*

MonthDayYear
Date
Phone Number*
Email*
example@example.com
Do you have a driver’s license? (If yes, please fill the following information)

YESNO
License #
State
Ex. date:(MM/DD/YYYY)

MonthDayYear
Date
If not, please explain how you will get to work.*
Have you ever been convicted of a crime?

NOYES
If yes, please explain with a detailed and honest answer # of convictions, nature of offense leading to conviction, how recently such offense was committed, sentence, and type of rehab?*
Do you have any friends or relatives who work here?

NOYES
If yes, please list the name here*
Have you applied to our agency previously?

YESNO
If yes, when?*

MonthDayYear
Date
Employment Information
List your current or most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list and explain any gaps in employment. (Please be sure to add good, detailed answers in the Resume Summary and Work Experience section. We will use this information provided there to send out to our clients with open positions that best suite you
Resume Summary
Full Name*
Position*
Years of Experience*
Salary Requirement*
Job Description*
Work Experience
Company Name*
Position*
Ending terms*
Duration*
Company Name*
Position*
Ending terms*
Duration*
Are you willing to work any overtime and any shift (Nights and Weekends)?

YESNO
Certification: I certify that the information provided on this application is truthful and accurate. I understand that

providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
Applicant Printed Name*
Date*

MonthDayYear
Date
Applicant Signature*

Clear
PRE-EMPLOYMENT SCREENING AUTHORIZATION FORM

Please be completely honest when answering the following questions to your best knowledge.
Can you pass a drug tet and background check?

YESNO
Background Acknowledgement
The information contained in this application is correct to the best of my knowledge. I hereby authorize PFL Services Inc and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigate consumer report may include but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. I further authorized any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge all information, verbal or written, pertaining to me, to PFL Services Inc or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources. I hereby release PFL Services Inc, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.
Drug Screening Acknowledgement
I hereby agree, upon a request made under the drug testing policy of PFL Services Inc to submit to a drug test and to furnish a sample of my urine. I understand and agree that my refusal or failure to cooperate with drug testing procedures recommended by PFL Services Inc will make me a candidate for immediate termination. Furthermore, I approve and authorize PFL Services Inc agents to send my samples for drug testing to a competent laboratory or testing center for proper screening test. I also approve and authorize the laboratory or testing center to disclose and discharge all documentation regarding and relating to the test conducted to me. I will hold free and harmless the company, company agents, and any testing research center the employer may utilize, implying that I won't sue or consider such parties for any charges that may come about because of such testing, including loss of work or some other sort of adverse occupation activity that may emerge because of the medication test, regardless of whether a business or laboratory delegate makes a mistake in the organization or investigation of the test or the detailing comes about. Finally, I understand and acknowledge that PFL Services Inc will require a drug screening after involvement in an accident during business hours or getting injured under circumstances suggesting that drug influence.
Certification: I certify that the information provided on this application is truthful and accurate. I understand that

providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
Applicant Printed Name*
Date*

MonthDayYear
Date
Applicant Signature*

Clear
WORK INTERVIEW ACKNOWLEDGMENT FORM
Working Interview Acknowledgement
I hereby authorize PFL Services Inc and its designated agents and representatives to deduct from my paycheck any or all adjustment to my assignment payment by hour agreement made. This adjustment will be depending on client assignment the employee will be required to work s full day, if employee quits assignment before end of work interview or doesn’t returns finished interview their paid will automatically be reduce to minimum wage per state requirement. I have been informed verbally by PFL Services Inc and its designated agents and representatives and I have acknowledged and agreed to these terms and conditions.
Initials*

Clear
Certification: I certify that the information provided on this application is truthful and accurate. I understand that

providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.
Applicant Printed Name*
Date*

MonthDayYear
Date
Applicant Signature*

Clear
Should be Empty:

EMPLOYMENT APPLICATION

Personal Information

Employment Information

Resume Summary

Work Experience

PRE-EMPLOYMENT SCREENING AUTHORIZATION FORM

Background Acknowledgement

Drug Screening Acknowledgement

WORK INTERVIEW ACKNOWLEDGMENT FORM

Working Interview Acknowledgement