Employment Application Thank you for taking the time to complete our online employment application. Please fill out the application below as completely as possible. This application will take approximately 15 minutes to complete. Personal Information Are you at least 18 years of age and do you have the legal right to work in the United States? Yes No First Name (Required) Middle Name Last Name (Required) Nickname / Preferred Name Street Address / Apartment City State / ZIP Code (Make Selection)AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingUS Other : US Armed Forces: PacificUS Other : US Armed Forces: EuropeUS Other : US Armed Forces: AmericaUS Other : American SamoaUS Other : Federated States of MicronesiaUS Other : GuamUS Other : Marshall IslandsUS Other : North Mariana IslandsUS Other : Puerto RicoUS Other : Virgin IslandsCanada : AlbertaCanada : British ColumbiaCanada : ManitobaCanada : New BrunswickCanada : NewfoundlandCanada : Northwest TerritoriesCanada : Nova ScotiaCanada : OntarioCanada : Prince Edward IslandCanada : QuebecCanada : SaskatchewanCanada : Yukon TerritoryMexico : AguacalientesMexico : Baja CaliforniaMexico : Baja California SurMexico : CampecheMexico : Coahuila de ZaragozaMexico : ColimaMexico : ChiapasMexico : ChihuahuaMexico : Distrito FederalMexico : DurangoMexico : GuanajuatoMexico : GuerreroMexico : HidalgoMexico : JaliscoMexico : MexicoMexico : Michoacan de OcampoMexico : MorelosMexico : NayaritMexico : Nuevo LeoMexico : OaxacaMexico : PueblaMexico : Queretaro ArtegaMexico : Quintana RooMexico : San Luis PotosiMexico : SinaloaMexico : SonoraMexico : TabascoMexico : TamaulipasMexico : TlaxcalaMexico : VeracruzMexico : YucatanMexico : Zaxatecas Home Phone (Required) - Area code and phone number Other Phone - Area code and phone number Email Address (Required) Cell Phone Carrier (Make Selection) Not Investigated Alltel At&t Bell Mobility CellularOne CellularOne MMS Centennial Wireless Do Not SMS Fido Kudo Mobile MetroPCS MTS Nextel Presidents Choice Qwest Wireless Rogers Wireless Sasktel Solo Sprint PCS Telus T-Mobile US Cellular Verizon Wireless Virgin Canda Virgin Mobile Upload your resume(valid formats are rtf, doc, docx) Resume - If you have a plain-text resume, paste it into the box below. Availability Are you willing to work temporary? YesNo Are you looking for a full-time career position? YesNo Are you looking for contract positions? Yes No When are you available to start? MMMMMMMMM 00 0000 What weekday hours are you available? First ShiftFirst and Second ShiftAll ShiftsFirst and Third ShiftSecond ShiftSecond and Third ShiftThird ShiftIf necessaryNot availableAM onlyPM only What weekend hours are you available? First Shift First and Second Shift All Shifts First and Third Shift Second Shift Second and Third Shift Third Shift If necessary Not available AM onlyPM only How many hours are you willing to work in a week? Part Time (0 to 20 hours a week) Full Time (More than 20 hours a week) Full Time + Overtime (more than 40 hours a week) Are you willing to work overtime? Yes No What is the minimum pay you desire? Hourly rate or annual salary How much notice will you need if a position is offered to you? One Day 1 Week 2 Weeks 3+ Weeks More Than One Day Same Day How many miles are you willing to travel to a position? What type of work are you looking for? Administrative Industrial Clerical Technical Medical Professional Other Education Enter most recent - Do not enter start and end date if the most recent is high school Name of School Type of school Community College High School Professional School Technical or Trade School University Other Street Address City State / ZIP Code MMMMMMMMMMMMMMMMMM Start Date (Month / Year) MMMMMMMMM 0000 End Date (Month / Year) MMMMMMMMM 0000 Degree Trade School Certification High School Diploma GED Attended College, No Degree College Coursework in Progress Associate Degree Bachelor's Degree Bachelor of Arts Bachelor of Science Master's Degree Masters of Arts Master of Business Administration Masters of Science Doctorate Degree Philosophiae Doctor Juris Doctorate MD Other Major Study Area Other Studies Recent Employment List most recent first Company Name Street Address City State / ZIP Code MMMMMMMMMMMMMMMMMM Supervisor Name Job Title Job Duties Start Date (Month / Year) MMMMMMMMM 0000 End Date (Month / Year) MMMMMMMMM 0000 Start Wage Hourly rate or annual salary End Wage Hourly rate or annual salary May we contact this employer for a reference check? Yes No Company Name Street Address City State / ZIP Code MMMMMMMMMMMMMMMMMM Supervisor Name Job Title Job Duties Start Date (Month / Year) MMMMMMMMM 0000 End Date (Month / Year) MMMMMMMMM 0000 Start Wage Hourly rate or annual salary End Wage Hourly rate or annual salary May we contact this employer for a reference check? Yes No Company Name Street Address City State / ZIP Code MMMMMMMMMMMMMMMMMM Supervisor Name Job Title Job Duties Start Date (Month / Year) MMMMMMMMM 0000 End Date (Month / Year) MMMMMMMMM 0000 Start Wage Hourly rate or annual salary End Wage Hourly rate or annual salary May we contact this employer for a reference check? Yes No Criminal Background & Drug Screen Have you been convicted of a crime in the last 7 years, other than a minor traffic violation? If yes, please explain: YesNo Are you willing to take a drug screening test? Yes No Skills Accounting - SpecialitiesEnvironmentalAutomation - Hardware Environmental EngineerAutomation - SoftwareEngineering Tech Automation - NetworksHealthcare SpecialtiesProgram Coordinator Industrial ServicesProperty ManagerManufacturing Management Public Relations/WriterInventorySupervisor InsuranceTrainerLegal Bank TellerMedicalBusiness H.R.BuyerPart Time LogisticsSales ManagementManagement Customer ServiceOffice ManagementManager OfficeMarketingOffice - Customer Service SecretaryOffice - Data EntrySecurity Office - Reception/SwitchboardSkilled TradesOffice - Secretarial Heating && Ventilation && Air ConditioningOffice - TranscriberMachinist Office - Clerks - FilingMaintenanceOffice - Clerks - Mailroom TechnicalOffice - Document ServicesVehicle - Forklift Operator Office - Records ManagementVehicle - DrivingComputer Operator Vehicle - Special License - CDLInformation SystemsMachine Operator IT AdministratorWriterNetwork Engineer ProgrammerComputer Repair TechComputer Tech Computer TrainerWeb Designer I certify that the statements I have made are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information. When I am employed I agree that if at any time I make claims for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of employer's selection, at employer's expense, as often as may be requested. I also agree that if I am employed, now or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination. I understand the term of my employment shall be limited to the duration of any assignment that I accept. I am aware that Public Law 91-508, known as the Fair Credit Reporting Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information as to the nature and scope of the inquiry or any report which is produced. I understand that I am applying for temporary or contract assignments. The completion of the this application process shall constitute a conditional offer of employment subject to my availability and the availability of customer assignments calling for the skill and qualifications that I possess, and I agree to consider acceptance of such assignments. Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button. Initials: This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.