Initial Application
*Name
Address
Apt #
City
State
Zip Code
*Phone
*E-Mail Address
What position(s) are you applying for?


 Light Industrial Skills
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 Office / Clerical Skills

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 Food Service Skills

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AVAILABILITY
Available for long term assignment
What type of assignment are you looking for?
I can handle
Heavy work
Medium work
Light work
Date available for work
Days of week available
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Day Hours
Night Hours
Type of transportation
Car
Public Transportation
Can you start immediately?
Are you willing to take a drug test to determine eligibility for a job assignment?

EXPERIENCE
Have you worked as a temporary employee before?
Staffing Agency Name
Temporary Job Site Location
Staffing Agency Name
Temporary Job Site Location

EDUCATION
Name and location of High School
Course or Major
Graduate?
Name of College or Trade School
Course or Major
Graduate?

PREVIOUS EMPLOYERS
Name of Employer and Supervisor
Positions and Responsibilities
Phone Number
How Long
Do you have any other skills you would like us to know about?
Best time to be contacted for interview

Wage Hourly Requirements


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