Form

Work Opportunity Application

We are an Equal Opportunity Employer
Name (As It Appears on Social Security Card)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Mark The Appropriate Boxes

If hired it will be necessary to present identification in accordance with IRCA requirements.
Hours you are willing to work
Days you are willing to wrok
Valid Driver's License (if required for job)
State License #
Class Endorsements
Restrictions Exp.
Mode of transportation
How many miles are you tilling to travel to work (one way)?
Are you enrolled in school?
Highest grade completed
Are you a high school graduate?
Do you have a GED?
Are you a college graduate?
Major/Degree
Occupational license(s)/Additional training
Do you consent to a background check?
Do you consent to a drug test?
CHECK OFF SKILLS BELOW WHICH YOU HAVE WORK EXPERIENCE IN:

The more information you provide, the better the chance of matching your qualifications to our client's requirements
Office Skills
Words Per Minute
Computer Skills

Please list all specified Software/Programs used and rate your skill (For example, MS WORD-Good or Quickbooks-Excellent
Software/Program Name
Rating
Software/Program Name
Rating
Software/Program Name
Rating
Software/Program Name
Rating
Software/Program Name
Rating
Software/Program Name
Rating
Office Job Titles
Medical/Dental
Retail
Restaurant
Construction
Welder
Mechanic
Trades
Heavy Equipment
Truck Driver
Endorsements
Production
Departments Worked
Laborer
Child Development
Misc. Skills
Language
Type a question
Language
Type a question
Language
Type a question
Misc. Skills
Traffic Control
Card #/Exp.Date/State Issued
Traffic Control
Card #/Exp.Date/State Issued
Traffic Control
Traffic Control Equipment
Make Model
Security
Card # Exp. Date
What type of work are you currently seeking?
Job Type Months of Experience
Where did you get the experience/training?
Job Type Months of Experience
Where did you get the experience/training?
Additional Information- Qualifications/Work Experience
Please list special skills and qualifications. Any additional information that you feel may be help to CPS staff considering your application.
Employment History

(A resume does not substitute) *Please list most current to least current
Name of Employer Employer Address
Employer Phone Number Kind Of Business
Supervisor's Name Your job Title
From (Month/Year) To (Month/Year)
Hours Worked Per Week (Average)
Supervision/Leadwork: Check areas you were responsible for:
Duties (List all duties you performed)
Reason For Leaving This Position
May We Contact This Employer
Name of Employer Employer Address
Employer Phone Number Kind Of Business
Supervisor's Name Your job Title
From (Month/Year) To (Month/Year)
Hours Worked Per Week (Average)
Supervision/Leadwork: Check areas you were responsible for:
Duties (List all duties you performed)
Reason For Leaving This Position
May We Contact This Employer
Name of Employer Employer Address
Employer Phone Number Kind Of Business
Supervisor's Name Your job Title
From (Month/Year) To (Month/Year)
Hours Worked Per Week (Average)
Supervision/Leadwork: Check areas you were responsible for:
Duties (List all duties you performed)
Reason For Leaving This Position
May We Contact This Employer
Name of Employer Employer Address
Employer Phone Number Kind Of Business
Supervisor's Name Your job Title
From (Month/Year) To (Month/Year)
Hours Worked Per Week (Average)
Supervision/Leadwork: Check areas you were responsible for:
Duties (List all duties you performed)
Reason For Leaving This Position
May We Contact This Employer
References

List three personal references that are not previous employers or relatives
Name Address/Phone Number
Name Address/Phone Number
Name Address/Phone Number
Emergency Contact Information
Emergency Contact Relationship
Phone Address
Where Do You Want To Work?
Check the counties that you will work
How Did You Hear About Us?
Please list the Publication/Website/Friend's Name/Employee Referral Name (If Applicable)
Authorization To Release Information
I authorize Certified Personnel Service Agency, Inc. (CPS) to check into my background and references and to investigate any information provided in my application for employment.
I respectfully request and authorize you to furnish CPS with any and all information that you may have concerning my employment and education record. Your cooperation in this reply will be used to assist CPS in determining my
qualifications for the position I am seeking with CPS.
I hereby agree to hold harmless any person or organization from any liability (suit, claim or other action) that may result from supplying the information requested.
Print Name (E-Signature) Date
THIS APPLICATION IS NOT COMPLETE UNTIL THE FOLLOWING STATEMENT HAS BEEN READ AND SIGNED
I certify that the information furnished in this application is true, accurate and complete to the best of my knowledge. I understand that any misrepresentation, misstatement or omission of facts may be justification for disqualification, refusal of employment, or termination if employed.
This application is not to be construed as a contract. CPS reserves the right to employ at will. This means that employment can be terminated with or without cause, and with or without notice, at any time, at the option of the company or at the option of the employee.
Please understand that filling out an application does not guarantee you a job with CPS or with any of our clients.
If you are contacted for employment with CPS, you may be required to complete additional employment documents. You will receive a copy of CPS’ Temporary Handbook, Return to Work Policy, Drug and Alcohol Policy, Safety Policy, Workplace Violence Policy, Anti-Harassment Policy, and Sick Leave Policy which describes the various policies and procedures that you, as a condition of your employment, must observe.
Accepting a job assignment with CPS does not guarantee you future job assignment with CPS clients or with CPS.
Print Name (E-Signature) Date
Please verify that you are human
Please Upload Resume Here

Cancelof
An Equal Opportunity and Affirmative Action Employer
La Grande Corporate
PO BOX 70
La Grande, OR 97850
541-963-6678
541-963-5213 FAX

Redmond Office
PO BOX 514
Redmond, OR 97756
541-504-9675
541-504-0590 FAX
Should be Empty:

Work Opportunity Application

Mark The Appropriate Boxes

CHECK OFF SKILLS BELOW WHICH YOU HAVE WORK EXPERIENCE IN:

Computer Skills

What type of work are you currently seeking?

Additional Information- Qualifications/Work Experience

Employment History

References

Emergency Contact Information

Where Do You Want To Work?

Authorization To Release Information

THIS APPLICATION IS NOT COMPLETE UNTIL THE FOLLOWING STATEMENT HAS BEEN READ AND SIGNED

An Equal Opportunity and Affirmative Action Employer