StaffMax Employment Application

StaffMax Employment Application

5620 Crawfordsville Rd, Ste U, Speedway, IN 46224
Personal Information:
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Birth Date*

MonthDayYear
Social Security Number*
Emergency Contact*
Relation to Emergency Contact*
Emergency Contract Phone Number*
Are You a U.S. Citizen?*

YesNo
Have you ever been convicted of a crime?*

YesNo
If yes, please provide date(s) of conviction and explanation:
Employment Desired:
Position Applying For*
Date You Can Start*

MonthDayYear
Salary Desired*
Locations Able to Work*

Plainfield/AvonBrownsburgAirport AreaWhitestownEast SidePark 100Mooresville
Have You Worked Here Before?*

YesNo
Have You Applied Here Before?*

YesNo
Education:
High School*
Name of High School Attended
Number of Years Attended
Graduated?

Yes
College
Name of College/University Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Trade School/Other
Name of Trade/Technical/Other School Attended
Number of Years Attended
Graduated?

Yes
Area of Study/Degree
Skills/Qualifications:
Skills*

Pick/PackRF ScanForkliftAssemblyShipping/ReceivingInventorySortingQuality ControlJanitorialLandscapingWeldingConstructionElectricalMachine OperatorClericalData EntryAdministrative AssistantAccounting
Qualifications
List any relevant certifications or qualifications
Current Employment:
Current Employer*
Name of Current Employer or NONE if not Employed
Position*
Salary*
Reason for Leaving?*
Start Date*

MonthDayYear
May We Contact?*

YesNo
Previous Employment:
Previous Employer*
Name of Previous Employer
Position*
Salary
Reason for Leaving?*
Start Date*

MonthDayYear
End Date*

MonthDayYear
Previous Employer*
Name of Previous Employer
Position*
Salary
Reason for Leaving?*
Start Date*

MonthDayYear
End Date*

MonthDayYear
References:
Reference 1*
Name of Reference
Relationship*
Phone*
Years Acquainted*
Email
Reference 2*
Name of Reference
Relationship*
Phone*
Years Acquainted*
Email
Cover Letter & Resume (Optional):
Cover Letter

Upload a File

Cancelof
Resume

Upload a File

Cancelof
Are you willing to undergo prescreening including drug/criminal/credit or other job specific screening as may be required by an assignment offered by StaffMax:*

YesNo
Send Application:
By clicking the submit button below, I certify 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 employment may be terminated at any time.

In consideration of my employment, I agree to conform to StaffMax's rules and regulations and I agree that my employment and compensation 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 StaffMax.
Should be Empty:

StaffMax Employment Application

Personal Information:

Employment Desired:

Education:

Skills/Qualifications:

Current Employment:

Previous Employment:

References:

Cover Letter & Resume (Optional):

Send Application: