Employment Application

Contact Information


First name *
Last name *
Address *
Address 2 *
City *
State *
Zip Code *
Phone *
Cell Number
E-Mail Address *
Positon Applying For * Available Start Date *
Desired Salary/Hourly Wage *
Are you a citizen of the U.S.?: *
YesNo
If no, Are you authorized to work in the U.S.?: *
YesNo
Have you ever been convicted of a felony?: *
YesNo
If yes: Please Explain: *
Best time to reach you: *
MorningAfternoonEvening
Type of Work: *
TemporaryTemporary-to-PermanentPermanentAll of the Above
Preferred Availability: *
1st Shift2nd Shift3rd ShiftNights & Weekends

Educational Background


High School

Name: *
Location: *
Dates Attended: *
From:
To:
Did you Graduate *YesNo



College

Name: *
Location: *
Dates Attended: *
From:
To:
Did you Graduate * YesNo
Degree: *
Major:
Minor:



Other Institution Name: *
Location: *
Dates Attended: *
From:
To:
Did you Graduate * YesNo
Degree: *
Major:
Minor:



Other Institution Name: *
Location: *
Dates Attended: *
From:
To:
Did you Graduate *YesNo
Degree: *
Major:
Minor:


Professional Background


Company:
Supervisor Name:
Address *
Address 2*
City *
State *
Zip Code *
Phone *
Job Title: *
Starting Salary: *
Ending Salary: *
Dates Employed: *
From:
To:
Reason for Leaving: *
Job Responsibilities: *
May we contact your Supervisor for a professional reference: *YesNo


Company:
Supervisor Name:
Address *
Address 2*
City *
State *
Zip Code *
Phone *
Job Title: *
Starting Salary: *
Ending Salary: *
Dates Employed: *
From:
To:
Reason for Leaving: *
Job Responsibilities: *
May we contact your Supervisor for a professional reference: *YesNo


Company:
Supervisor Name:
Address *
Address 2*
City *
State *
Zip Code *
Phone *
Job Title: *
Starting Salary: *
Ending Salary: *
Dates Employed: *
From:
To:
Reason for Leaving: *
Job Responsibilities: *
May we contact your Supervisor for a professional reference: *YesNo


Professional References


Please list 3 Professional References

Name *
Company *
Phone *
Professional Relationship
Name *
Company *
Phone *
Professional Relationship
Name *
Company *
Phone *
Professional Relationship









Release and Consent


Should this application lead to a video interview with ProfiStaff, LLC, for good and valuable consideration, the receipt of which is hereby acknowledged, I hereby consent to the photographing of myself and the recording of my voice and the use of these photographs and/or recordings singularly or in conjunction with other photographs and/or recordings for advertising, publicity, commercial or other business purposes. I understand that the term "photograph" as used herein encompasses both still photographs and motion picture footage.
I further consent to the reproduction and/or authorization by ProfitStaff, LLC to reproduce and use said photographs and recordings of my voice, for use in all domestic and foreign markets. Further, I understand that others, with or without the consent of ProfitStaff, LLC may use and/or reproduce such photographs and recordings.
I hereby release ProfitStaff, LLC, and any of its associated or affiliated companies, their directors, officers, agents, employees and customers, and appointed advertising agencies, their directors, officers, agents and employees from all claims of every kind on account of such use.


I AGREE

Checking this box serves as your official signature and you fully agree with the above statement






Disclaimer and E-Signature


If offered temporary employment, all persons, including U.S. citizens, will be required to present original documents verifying identity and employment eligibility in compliance with the Federal Immigration Reform and Control Act of 1986.
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
I understand that a routine inquiry or investigation may be made during initial or subsequent processing to provide information applicable to the job for which I am applying. I hereby grant ProfitStaff, LLC permission to access those records that it deems necessary and release all parties from liability.
I further understand that the position for which I am applying may be a temporary opportunity and if so, I agree that I serve at the will of ProfitStaff, LLC’s client. I agree that, if employed as a temporary employee, ProfitStaff, LLC reserves the right to terminate my employment at any time. I fully understand and agree that if accepted as a temporary employee, I will not be entitled to annual or sick leave, paid holidays, health or dental insurance, grievance rights or other benefits normally associated with permanent employment.
I understand that if the position for which I am applying is a permanent position for ProfitStaff, LLC’s client, I agree to correspond only through ProfitStaff and not directly with the client until permanent employment is offered and I have officially accepted an employment agreement with ProfitStaff, LLC’s client.

I AGREE

Checking this box serves as your official signature and you fully agree with the above statement