APPLICATION (SOLICITUD)

Online Application
Name*

First NameMiddle NameLast NameSuffix
Date Available*

MonthDayYear
Date
Hourly Rate*
Main Number*
Please enter a valid phone number.
Alternate Number
Please enter a valid phone number.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
What days of the week are you available?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
What shift are you available to work?*

1st Shift2nd Shift3rd Shift
Have you ever worked at Accent Staffing in the past?*

YESNO
Positions you are interested in*

PermanentFull-TimePart-TimeShort-Term
Have you been convicted of a Felony or have any charges pending against you?*

YESNO
Name of High School: blanks*
Location: City / State*
year did you graduate? blank*
Name of College/Trade School: Name of School
Location: City / State
year did you graduate? blankDegree? Type of Degree

Current / Most recent employer*

	Enter the information below
Company Name
Start Date
End Date
City / State
Title / Position
Hourly Rate
Reason for Leaving

Previous Employer*

	Enter the information below
Company Name
Start Date
End Date
City / State
Title / Position
Hourly Rate
Reason for Leaving

Previous Employer*

	Enter the information below
Company Name
Start Date
End Date
City / State
Title / Position
Hourly Rate
Reason for Leaving

What type of work are you looking for?*

IndustrialClericalBoth
Signature*

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Date

MonthDayYear
Date

Shield Questionaire Regarding your Consumer Report

In order to obtain the most accurate information, this questionnaire helps Accent Staffing to better identify information that does or does not relate to you. This document will not become a part of your personnel file, if hired.
Full Legal Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Date
Gender

MaleFemale
Race
Drivers License / State ID Number
State of Issue
Current Address*
Previous Address
Previous Address
Military Service*

NOYES
Employment History: Last four (4) years starting with your most recent

Current/Most Recent Employer

	Enter the information below
Company Name
Start Date
End Date
City / State
Phone Number
Contact Name

Previous Employer

	Enter the information below
Company Name
Start Date
End Date
City / State
Phone Number
Contact Name

Previous Employer

	Enter the information below
Company Name
Start Date
End Date
City / State
Phone Number
Contact Name

Previous Employer

	Enter the information below
Company Name
Start Date
End Date
City / State
Phone Number
Contact Name

NOTICE & DISCLOSURE - BACKGROUND INVESTIGATION

Pursuant to OKLAHOMA law, the following disclosures are provided to our state residents. OKLAHOMA residents or employees only: By signing below, you acknowledge receipt of the NOTICE BACKGROUND INVESTIGATION pursuant to Oklahoma Law. Please check the box if you would like to receive a copy of your consumer report, free of charge, if one is obtained by Accent Staffing.

NOTICE BACKGROUND INVESTIGATION

In connection with your employment with Accent Staffing, notice is hereby given that aconsumer report and/or investigative consumer report may be obtained from a consumerreporting agency for employment purposes. These reports may contain information about yourcharacter, general reputation, personal characteristics and mode of living, whichever areapplicable. They involve personal interviews with sources such as your neighbors, friends, or associates. The reports may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, education or employment history,
or other background checks. You have the right, upon written request made within a reasonable time after the receipt of this notice to request disclosure of the nature and scope of any investigative consumer report prepared by contacting Accent Staffing and Shield Screening at 6810 East 121st St S, Bixby, OK 74008; phone 1-800-260- see www.shieldscreen.com. The scope of this notice and below authorization is not limited to the present and, if you are hired, will continue throughout the course of your employment and allow Accent Staffing to conduct future screenings for retention, promotion or reassignment, as permitted by law unless revoked by you in writing.

ACKNOWLEDGEMENT AND AUTHORIZATION

By signing below I hereby authorize the obtaining of consumer reports and/or investigative consumer reports by Accent Staffing at any time after receipt of this authorization and throughout the course of my employment, if applicable. All information provided is true and correct to the best of my knowledge.
Name*

First NameLast Name
Signature*

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Date

MonthDayYear
Date
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Online Application

Clerical Skills Sheet

Industrial Skills Sheet

Employment Packet

Shield Questionaire Regarding your Consumer Report