Employment Application

STEP 1 of 2
                                                                                                                                                                                                                                                                        * - Required Information
Applicant Information - If selected for employment, the below information will be used during the hiring process. Please use your legal names.
Last Name  * First Name  * Middle Name
Are you at least 18 years of age?  *     Address  * City  *
State  * Zip  * County  *
Email Primary Phone  * Secondary Phone
Type of Position Target Market
(Pick nearest location to you)
Are you a US Citizen
or Permanent Resident  *		     If No, are you legally authorized to
work in the US		     Last 4 SSN  *
Have you ever worked for STAFFLOGIX  *     If Yes, when(From/To Dates)   
Have you ever plead guilty, no contest, or been convicted of a felony or misdemeanor crime since the age of 18, including such moving violations as driving under the influence of a drug or alcohol, which were not later sealed or expunged?   *  

If Yes, please give dates and details of such conviction in the space provided below.
NOTE: Answering "YES" to the above questions does not constitute an automatic bar to employment. Each case will be determined on its own merits and reviewed individually.

Date Available(MM/DD/YYYY)  * Desired Hourly Rate  *   
 
Emergency Contact
Name  * Relation  *
Primary Phone  * Secondary Phone
 
Education
Please enter the details of highest education you have obtained.
Institution Name  * Location  * Major
Did you graduate?  *     Graduation(Month/Year)  Degree
 
Employment
Please enter the details of the last three positions you have worked.
 
Position # 1
Company Name Job Title
Address City State, Zip 
Starting Salary/ Hourly Rate Ending Salary/ Hourly Rate
From(Month/Year)  To(Month/Year)   
Supervisor Name Supervisor Phone May we contact your previous employer for a reference    
Responsibilities
Reason for leaving
If gap in employment is longer than 90 days please explain
Position # 2
Company Name Job Title
Address City State, Zip 
Starting Salary/ Hourly Rate Ending Salary/ Hourly Rate
From(Month/Year)  To(Month/Year)   
Supervisor Name Supervisor Phone May we contact your previous employer for a reference    
Responsibilities
Reason for leaving
If gap in employment is longer than 90 days please explain
Position # 3
Company Name Job Title
Address City State, Zip 
Starting Salary/ Hourly Rate Ending Salary/ Hourly Rate
From(Month/Year)  To(Month/Year)   
Supervisor Name Supervisor Phone May we contact your previous employer for a reference    
Responsibilities
Reason for leaving
If gap in employment is longer than 90 days please explain
 
References
Please provide three professional references.
 
Reference # 1
Reference Name  * Relation  *
Company Name  * Phone  *
Reference # 2
Reference Name  * Relation  *
Company Name  * Phone  *
Reference # 3
Reference Name  * Relation  *
Company Name  * Phone  *
 
Military Service
Branch Rank at Discharge
From/ To Type of Discharge
If other than honorable discharge, please explain (200 characters)
 
Voluntary Affirmative Action Data
We are required by Federal Law to maintain records of the race and sex of all applicants, and to analyze such data in connection with our affirmative action program. In order to include such data in our analysis, and for that reason only, we invite you to indicate your sex and to which race/ethnic categories apply to you. This information is voluntary and will not be used when considering you for employment. If you do not wish to participate, please indicate by selecting below.
 
Do you wish to participate  *    
 
Gender Racial or Ethnic Group
 
Skills and Resume
Please select the top 3 skills
 
Skill # 1 Skill # 2 Skill # 3

Paste Your Resume