I am applying for
Location:
Salary requirement $
NOTE: All applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, age, marital status, national origin, physical or mental handicap. The following information is requested in order to help us make the best possible placement. Staffing Solutions subscribes to a DRUG FREE WORK PLACE. YOU MAY BE REQUIRED TO SUBMIT TO A DRUG SCREEN AS PAT OF YOUR INTIAL APPLICATION PROCESS. All portions of this application pertaining to you must be completed.
Date You can Start?
Full Time? 
Have you ever worked for Staffing Solutions 
If Yes, when?
POSITION DESIRED
PERSONAL
Social Security Number (last four numbers)
First/ Given Name:
Middle Name (compete):
Last Name:
NOTE: Enter name exactly as it appears on official documents. Do not use nick names.
WORK EXPERIENCE
Permanent Address:
City/Town:
State:
Home Phone Number:
Cell Phone Number:
NOTE: Please account for all time for the last five (5) years. Include periods of unemployment and any prior employment by Staffing Solutions. Begin with your most recent job. DO NOT REFERENCE RESUME.
position.
Present Employer:
Address:
Name & title of your supervisor:
Phone Number:
Your title and description of your duties:
From Mo/Yr
To Mo/Yr
Starting Salary
Ending Salary
Reason for Leaving?
Employer:
Address:
Name & title of your supervisor:
Phone Number:
Your title and description of your duties:
From Mo/Yr
To Mo/Yr
Starting Salary
Reason for Leaving?
Ending Salary
Employer:
Address:
Name & title of your supervisor:
Phone Number:
Your title and description of your duties:
From Mo/Yr
To Mo/Yr
Starting Salary
Ending Salary
Reason for Leaving?
EDUCATION
SCHOOL      CITY AND STATE          YRS. ATTEND      GRADUATED?
GENERAL INFORMATION
NOTE: Federal law prohibits the employment of unauthoriezed persons. Should you be hired, satisfactory proof of employment authorization and idenity will be required within three (3) working days of hire. Faliure to submit such proof with in the required time will result in immediate dismissal. 
If hired, can you furnish proof of citizenship or authorization to work?
If you are under the age of 18 years old, do you have a work permit?
If required, would you be willing to work:
1st Shift
2nd Shift
3rd Shift
Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations, in a safe or efficient manner?
Have you ever been convicted of a felony in the past five (5) years? *If yes, provide explaination here;
Do you have any relatives or personal friends working for Staffing Solutions?
If yes, who?
Relationship:
PLEASE READ AND CHECK BOX
NOTE: PLEASE READ THIS SECTION BEFORE YOU CHECK BOX OF THIS ELECTRONIC EMPLOYMENT APPLICATION FORM. I certify that answers given in this application are true and complete to the best of my knowledge. I understand that any false statements on this application could result in disqualification from the application process or if employed seperation from Staffing Solutions. I understand the employer is not obligated to offer the position to me, even after completing this application or following a job interview. I understand Staffing Solutions has certain rules and procedures, which must be followed. I agree that if I am employed I will follow the rules of Staffing Solutions or be subject to disciplinary action that could mean dismissal. I understand Staffing Solutions is an at-will employer, which means that any term of employment is for no definite period of time regardless of the date or payment of wages. If I am employed, such employment may be ended with or without cause or notice. No verbal agreements made during any application or interview process can be relied upon unless such agreements are in writing and signed by the owner or President of the Company including the at-will statement in this application.

I understand if Staffing Solutions hires me, my employment is conditional on my ability to provide proof of wrk authorization and identity as required by Fedreal Law and the completion of any post-employment requirements of the employer.
Your Name:
Date:
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
n/a
YesNo
YesNo
YesNo
I agree