Fill out this E-Application and we will contact you about the job opportunity or type of job opportunities you are interested in.
Category:
Location:
Type:
First Name:
Middle Name:
Last Name:
Suffix:
(Jr., Sr., etc.)
Other Name:
(Maiden, Married)
Nickname:
Street Address:
City:
State:
Zip Code:
Lived Here Since:
Phone:
Pager:
Other Phone:
Email:
Social Sec. #:
Birthday:  
How did you hear about us?:
 
Minimum Pay Rate:
  $ per
When are you available to work?:
 
Full-Time, Part-Time  
Days, Evenings, Holidays
1st Shift, 2nd Shift, 3rd Shift
Dates available to work:
 
From:    
To: Indefinite (Or, select below:)
     
Areas of Town?:
 
All, North, South, East, West
Do you have reliable transportation?:
  Yes, No
EDUCATION - HIGH SCHOOL:
School Name:
School City, State:
GPA:
Graduated?: Yes, No, Not Yet
EDUCATION - COLLEGE:
School Name:
School City, State:
GPA:
Graduated?: Yes, No, Not Yet
Major:
Minor:
Diploma/Degree:
EDUCATION - GRADUATE/PROFESSIONAL:
School Name:
School City, State:
GPA:
Graduated?: Yes, No, Not Yet
Diploma/Degree:
EDUCATION - OTHER:
School Name:
School City, State:
GPA:
Graduated?: Yes, No, Not Yet
Diploma/Degree:
EMPLOYMENT HISTORY:
Start with your present or most recent.
Include any job-related military service assignments and volunteer activities.
Employer #1:
City:
State:
Phone:
Supervisor:
Supervisor Title:
Shift:
Emp. From:  
Emp. To:  
Starting Pay: $ per
Final Pay: $ per
Job Title:
Duties:
Still Employed Here?: Yes (If No, complete below:)
Reason For Leaving:
Employer #2:
City:
State:
Phone:
Supervisor:
Supervisor Title:
Shift:
Emp. From:  
Emp. To:  
Starting Pay: $ per
Final Pay: $ per
Job Title:
Duties:
Still Employed Here?: Yes (If No, complete below:)
Reason For Leaving:
Employer #3:
City:
State:
Phone:
Supervisor:
Supervisor Title:
Shift:
Emp. From:  
Emp. To:  
Starting Pay: $ per
Final Pay: $ per
Job Title:
Duties:
Still Employed Here?: Yes (If No, complete below:)
Reason For Leaving:
PLEASE LIST THREE REFERENCES:
Reference #1:
Title:
Phone:
Reference #2:
Title:
Phone:
Reference #3:
Title:
Phone:
Have you ever applied at a Staffing Partners Office?:
  Yes, No
If Yes, Where?:
If Yes, When?:
Have you ever been employed at a Staffing Partners Office?:
  Yes, No
If Yes, Where?:
If Yes, When?:
Have you ever been granted a security clearance?:
  Yes, No
Have you ever been bonded?:
  Yes, No
Have you ever been convicted of a crime since the age of 18?:
  Yes, No
Or, have you been convicted of a crime and tried as an adult if younger than 18?:
  Yes, No
If Yes for either criminal conviction, explain:
 
CRIMINAL RECORD CHECKS WILL BE PERFORMED
REFERENCE CHECK RELEASE
I hereby request and authorize any and all of my past or present employers, educational institutions, business associates, and government bodies to release any and all documents, records, and other information relating to my backgrounds and qualifications for present or future employment with Staffing Partners or its authorized agents and representatives. I understand that all information obtained will be held in confidence and I acknowledge that a copy or facsimile of this document carries the same validity as the original.
I hereby release and discharge Staffing Partners, its officers, directors, employees, agents, and representatives and any person or entity so providing information from any and all liability of every nature and kind arising from the furnishing of such documents, records, and other information.
The entering of the Name, Social Security Number, and Date information below will constitute a legal Electronic Signature.
Full Name:
Other Names:
Social Sec. #:
Date:
I hereby declare that all statements contained in this application and given orally are true and correct and understand that false or inaccurate information in the application will be the basis for termination.
I will hold harmless, indemnify, and defend Staffing Partners from all claims and loss including but not limited to personal illness and injury resulting from supplying false or misleading information.
I hereby authorize Staffing Partners to investigate my background, including a criminal records check, and verify this information.
I also authorize Staffing Partners to release the information contained herein and its findings and work history of my employment to other firms or persons upon request.
I understand and agree:
  • that if employed, my employment will not be for any fixed period of time and may be terminated by Staffing Partners at any time without liability except for wages earned;
  • that the term of my employment with Staffing Partners shall be limited to the duration of any temporary assignments hereunder and my employment is "at will";
  • that I may be expected to work on a wide variety of job assignments in the service area of this office and agree to accept assignments for which I am qualified as they become available;
  • that my failure to report to an assignment for work will indicate I have quit;
  • to submit to a drug screen upon request or as specified in Staffing Partners' substance abuse policy;
  • not to publish, disclose, or utilize any confidential information of your company or your clients where you send me to work and I will assign and disclose to your client any invention perfected or conceived during my hours of work for such client and will sign all papers necessary to enable your client to patent these inventions and to obtain copyrights;
  • that I will not solicit nor accept any work with the clients of Staffing Partners without prior written notice to Staffing Partners;
  • that I have received and read Staffing Partners' Policies and agree to follow them.
The entering of the Name and Date information below will constitute a legal Electronic Signature.
Full Name:
Date: