Employee Application

Last 4 numbers of your SSN:

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Salutation:

*First Name:

Middle Initial:

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*Last Name:

Nickname:

Address:

* City:

* State:

* Zip:

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*Home Phone:
Enter only numbers, area code first:

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Cell Phone:
Enter only numbers, area code first:

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Other Phone:
Enter only numbers, area code first:

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Email:

In case of emergency, notify name:

Emergency Phone:
Enter only numbers, area code first:

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Check if you are legally authorized to work in the United States:

* How did you hear of us:

I have viewed this page.

* What position are you applying for:

Date available for work:

May, 2013

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Today

Clear

Minimum rate per hour:

Days you are available to work full-time:

Mon

Tue

Wed

Thr

Fri

Sat

Sun

What shifts you are available to work:

Shift 1

Shift 2

Shift 3

Preferred Shift:

Shift 1

Shift 2

Shift 3

What times are you available to work from:

Invalid value

To:

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Checking the below boxes indicates YES:

Do you have transportation:

Will you accept a same day assignment:

Will you accept a long term assignment:

Are you available part-time:

Are you available full-time:

Are you available temp-hire:

Are you available direct-hire:

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City

Yes

Ardmore OK

Austin TX

Big Spring TX

Cedar Park TX

Duncan Area OK

Edmond OK

Georgetown TX

Hobbs NM

Hutto TX

Lawton OK

Midland TX

Moore OK

Norman OK

Odessa TX

Oklahoma City OK

Permian Basin TX

Pflugerville TX

Round Rock TX

San Angelo TX

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Skill Title

Yes

Skill Set: 0010 ADMINISTRATIVE ASSISTANT

General

Medical

Legal

Marketing

Manufacturing

Financial

Skill Set: 0010 BOOKKEEPING

Assistant

Full Charge

Accts Payable

Accts Receivable

Collections

Reconciliation

Payroll

Tax Preparation

Software

Manual

Auditing

Budget Analysis

Invoicing

Skill Set: 0010 OFFICE

Customer Service

Telemarketing - In

Telemarketing - Out

Filing

Mail Room

Skill Set: 0010 OFFICE EQUIPMENT

Typewriter

Copier

Fax

Postage Meter

Calculator

Projector

Computer

Internet

Scanner

PDA

Skill Set: 0010 RECEPTIONIST

Switchboard

Headphone

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Previous Employment #1

Dates of employment:

From:

To:

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
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22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

Name of employer:

Address:

City, State, Zip:

Phone:

Invalid value

Supervisor:

Job Position:

Pay per hour:

Reason for leaving:

Previous Employment #2

Dates of employment:

From:

To:

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

Name of employer:

Address:

City, State, Zip:

Phone:

Invalid value

Supervisor:

Job Position:

Pay per hour:

Reason for leaving:

Previous Employment #3

Dates of employment:

From:

To:

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

Name of employer:

Address:

City, State, Zip:

Phone:

Invalid value

Supervisor:

Job Position:

Pay per hour:

Reason for leaving:

Previous Employment #4

Dates of employment:

From:

To:

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

May, 2013

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11
20	12	13	14	15	16	17	18
21	19	20	21	22	23	24	25
22	26	27	28	29	30	31	1
23	2	3	4	5	6	7	8

Today

Clear

Name of employer:

Address:

City, State, Zip:

Phone:

Invalid value

Supervisor:

Job Position:

Pay per hour:

Reason for leaving:

Temporary Employment

Check if you have ever used a recruiting firm to obtain employment (temp or perm):

FIRM # 1

FIRM # 2

Firm name:

Address:

City, State, Zip:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

Firm name:

Address:

City, State, Zip:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

I have viewed this page.

High School Education

Name of high school:

High school degree:

High school diploma/certificate:

Business or Other Education

Name of school/program:

School/program degree:

School/program diploma/certificate:

College Education

Name of college:

College degree:

College diploma/certificate:

I have viewed this page.

ENTER THE APPROPRATE INFORMATION IN THE SPACE PROVIDED

Previous Employment #1

Previous Employment #2

Previous Employment #3

Previous Employment #4

Temporary Employment

FIRM # 1

FIRM # 2

High School Education

Business or Other Education

College Education