Staff-1 Employment Application

Staff-1 Employment Application

Please complete this form to apply for a position with our company.
Where would you like to work?
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Position Applying for: (Check all that apply)
Available Start Date

MonthDayYear
Date
Days/Times you are available to work
Average number of hours per week you would like to work: (Amount of hours per week are not guaranteed. Average shift is 5 hours.)
Education
Education Background (highest level achieved):
Work Experience

Please list all jobs held in the last 5 years as well as prior employment with Staff-1 if applicable.
Military Service
Branch
Rank
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
References (Please list 3)
Skills & Qualifications
Relevant Skills (list any technical, soft or job-related skills):
Registrations, Certifications or Special Training (if applicable):
Check all tasks you can do without a reasonable accommodation:
Additional Information I
Have you worked for Staff-1 previously?
Please provide approximate dates of any previous employment with Staff-1
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
How did you hear about this job with Staff-1 (e.g., Referral, Online search or jobsite, Staff-1 website, etc.?):
Do you have any friends or family that work or have worked for Staff-1?
Additional Information II

Please note a background screening is required for employment with Staff-1.
Have you been convicted of a crime?
If yes, please list all convictions and dates (including pending charges)
Additional Comments
Applicant's Declaration:

I confirm that the information provided is accurate and complete to the best of my knowledge. I understand that any omissions or false or misleading information may disqualify me from consideration for employment or result in termination if discovered after hire. I further affirm that I am legally authorized to work in the United States and can provide documentation verifying my identity and employment eligibility as required by federal law. I acknowledge that, if hired, my employment will be on an at-will basis, meaning that either I or the company may terminate the employment relationship at any time, with or without cause or notice, subject to applicable law.
Signature
Name

First NameLast Name
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Staff-1 Employment Application

Education

Work Experience

Skills & Qualifications

Additional Information I

Additional Information II

Applicant's Declaration: