Employee Application
Last 4 numbers of your SSN:
Salutation:
v
*First Name:
Middle Initial:
*Last Name:
Nickname:
Address:
* City:
* State:
v
* Zip:
*Home Phone:
Enter only numbers, area code first:
Cell Phone:
Enter only numbers, area code first:
Other Phone:
Enter only numbers, area code first:
Email:
In case of emergency, notify name:
Emergency Phone:
Enter only numbers, area code first:
Check if you are legally authorized to work in the United States:
* How did you hear of us:
v
 
* What position are you applying for:
Date available for work:
v
Minimum rate per hour:
Days you are available to work full-time:
 
What shifts you are available to work:
Preferred Shift:
What times are you available to work from:
   
To:
   
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:
 
City 
Yes 
Belton,MO
Blue Springs,MO
Gardener,KS
Gladstone,MO
Grandview,MO
Kansas City Missouri
Kansas City North,MO
Lawrence,KS
Lenexa,KS
Liberty,MO
Mirriam,KS
New Century,KS
North Kansas City,MO
Olathe,KS
Overland Park,KS
Shawnee Mission,KS
St.Joseph,MO

Skill Title 
Yes 
[Collapse]Skill Set: 0010 ADMINISTRATIVE ASSISTANT
 General
 Medical
 Legal
 Marketing
 Manufacturing
 Financial
[Collapse]Skill Set: 0010 BOOKKEEPING
 Assistant
 Full Charge
 Accts Payable
 Accts Receivable
 Collections
 Reconciliation
 Payroll
 Tax Preparation
 Software
 Manual
 Auditing
 Budget Analysis
 Invoicing
[Collapse]Skill Set: 0010 OFFICE
 Customer Service
 Telemarketing - In
 Telemarketing - Out
 Filing
 Mail Room
[Collapse]Skill Set: 0010 OFFICE EQUIPMENT
 Typewriter
 Copier
 Fax
 Postage Meter
 Calculator
 Projector
 Computer
 Email
 Internet
 Scanner
 PDA
[Collapse]Skill Set: 0010 RECEPTIONIST
 Switchboard
 Headphone

ENTER THE APPROPRATE INFORMATION IN THE SPACE PROVIDED


Enter as much information as you can. More details will help us better serve you.

Previous Employment #1

Dates of employment: From: To:
v
v
Name of employer:
Address:
City, State, Zip:
v
Phone:
Supervisor:
Job Position:
Pay per hour:
Reason for leaving:

Previous Employment #2

Dates of employment: From: To:
v
v
Name of employer:
Address:
City, State, Zip:
v
Phone:
Supervisor:
Job Position:
Pay per hour:
Reason for leaving:
   

Previous Employment #3

Dates of employment: From: To:
v
v
Name of employer:
Address:
City, State, Zip:
v
Phone:
Supervisor:
Job Position:
Pay per hour:
Reason for leaving:

Previous Employment #4

Dates of employment: From: To:
v
v
Name of employer:
Address:
City, State, Zip:
v
Phone:
Supervisor:
Job Position:
Pay per hour:
Reason for leaving:
 

Temporary Employment

FIRM # 1

FIRM # 2

Firm name:
Address:
City, State, Zip:
v
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:
v
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:
 

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:
               
      GENERAL EMPLOYMENT
I agree that I have been informed of the requirements of the work for which I am applying, and that the information on this application is correct and complete to the best of my knowledge. I understand that it shall be grounds for denial of employment and immediate dismissal if any of the information contained herein is found to be untrue or misleading or if there are any misrepresentations or omissions of any kind whatsoever. Applicants must only answer the questions on the application. Applications with extra comments will be rejected. AMERISEARCH STAFFING accepts only original, not copies of applications. Applicants must electronically sign the application online or apply in person. I authorize you and all former employers, given by me as references, to answer all questions and to give all information in connection with this application or in any way concerning me. I agree that I will obtain your permission before discussing permanent employment with your client. I understand that any information I learn while working for a client is to be kept confidential. Employees and former employees are prohibited from releasing to any other party any information whatsoever about AMERISEARCH STAFFING that is of a confidential nature or which could be deemed a “trade secret.” Employees or former employees are prohibited from using in any manner whatsoever information that is confidential, proprietary, or privileged, whether for their personal benefit or gain or for that of any other person. Any information that has not been disclosed publicly in writing should be treated as confidential and proprietary. I will hold you harmless from any claims including, but not limited to, personal injury or illness as a result of my providing false or misleading information on this application. I hereby acknowledge that my employment is “at will” and not for a specific period of time, and that I may resign at anytime and AMERISEARCH STAFFING may terminate my employment at anytime, with or without cause, and with or without notice.

EMPLOYMENT RELATIONSHIP
The relationship between AMERISEARCH STAFFTING and our candidates or employees can be a mutually relationship, but it requires each employee and candidate to continually stay in touch with our AMERISEARCH STAFFTING office in order for us to have updated contact and availability information. I understand that I may be required to work various assignments throughout the course of my employment. I further understand that the hours, days, salary, and type of work may vary. I understand and agree that as an employee I will contact AMERISEARCH STAFFING at the end of an assignment to request an additional assignment. I understand that failure to contact AMERISEARCH STAFFING with 24 hours of the completion of an assignment will be considered a voluntary resignation. I also have been informed that failure to contact AMERISEARCH STAFFING within 24 hours will have adverse effect on unemployment benefits. I have provided AMERISEARCH STAFFING with any limitation I have that would prevent me from accepting assignments.

RELEASE OF ALL CLAIMS AGAINST CUSTOMERS
I am applying for temporary work assignments with AMERISEARCH STAFFING. I understand that AMERISEARCH STAFFING provides temporary workers for its customer to work at the customers’ site. In accepting any work assignment, I acknowledge that I am a temporary employee of AMERISEARCH STAFFTING, and I am not an employee of AMERISEARCH STAFFING customer. If I am ever injured in the course of my work for AMERISEARCH STAFFING, I agree that I will look only to AMERISEARCH STAFFING for Workers’ Compensation coverage and not to the customer for any recovery. For myself, and on behalf of my heirs. executor, personal representative and assigns, I waive, release and forever discharge any claim that I may now have or that may later develop against any customer of AMERISEARCH STAFFING which directly or indirectly arises out of any injures which may occur to me while on a temporary work assignment for AMERISEARCH STAFFING. In agreeing to this Release, I understand that I am not waiving or releasing any claims which I may have against the Workers’ Compensation coverage paid by AMERISEARCH STAFFING.
EMPLOYMENT BY AMERISEARCH CUSTOMERS
AMERISEARCH STAFFING is your employer. AMERISEARCH STAFFING employees may not seek or accept employment by any AMERISEARCH STAFFING client unless special terms are agreed upon by AMERISEARCH STAFFING and the client. These terms consist of, remaining on the AMERISEARCH STAFFING payroll for a specified period, or the customer paying a settlement fee to AMERISEARCH STAFFING. If an employee seeks and/or receives employment from one of its customers without the consent of AMERISEARCH STAFFING, the employee agrees to pay a settlement fee of twenty percent (20%) of the employee’s first year’s salary. AMERISEARCH STAFFING has a probation period of ninety (90) days – you may be released at any time during this period.
ASSIGNMENT ABANDONMENT
It is the employee’s responsibility to notify AMERISEARCH STAFFING if unable to start or complete an assignment once accepted. Any employee who walks off an assignment before the end of the work day or does not return to an assignment without prior notice to AMERISEARCH STAFFING, will be deemed to have abandoned the assignment and will be subject to disciplinary action which includes the following:
(1) Immediate termination.
(2) Any hours pending for current or future payroll will be reduced to minimum wage.
I understand that I may be required to work various assignments throughout the course of my employment. I further understand that the hours, days, salary, and type of work may vary. I understand and agree that as an employee I will contact AMERISEARCH STAFFTING at the end of an assignment to request an additional assignment. I understand that failure to contact AMERISEARCH STAFFTING with 24 hours of the completion of an assignment will be considered a voluntary resignation. I also have been informed that failure to contact AMERISEARCH STAFFTING within 24 hours will have adverse effect on unemployment benefits. I have provided AMERISEARCH STAFFTING with any limitation I have that would prevent me from accepting assignments.
UNEMPLOYMENT COMPENSATION
Since the relationship between AMERISEARCH STAFFING and the employee is one of employment-at-will, I understand that employment by AMERISEARCH STAFFING commences when I am assigned to a AMERISEARCH STAFFING client and I begin working at the client’s premises or job site. The employment-at-will relationship with AMERISEARCH STAFFING is terminated and I have voluntarily quit employment with AMERISEARCH STAFFING upon conclusion of each work assignment and/or if I fail to report to AMERISEARCH STAFFING for work the day after the conclusion of a work assignment. Upon the conclusion of each assignment or if I fail to report to work the day following completion of a daily work assignment, I understand and agree that I have voluntarily quit. I agree immediately to notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice within 24 hours, you may assume that I am not available for the assignment, and am not ready, willing and able to work.

ANTI-HARASSMENT POLICY
AMERISEARCH STAFFING seeks to provide a work atmosphere that is free from intimidation, harassment and discrimination. Therefore, harassment of any kind by employees or third persons will not be tolerated. This policy against harassment of any kind applies throughout our work environment, whether in the office, on work assignments outside the office, at company-sponsored social events, or otherwise. For these purposes “harassment” includes, but is not limited to, slurs, jokes, and other verbal, graphic, or physical conduct relating to an individual’s race, color, sex, religion, national origin, age, handicap, disability, marital status, or for any other reason. Some examples of harassment include: unwelcome requests for sexual favors or sexual advances, verbal harassment, such as sexual innuendoes, suggestive comments, and jokes of a sexual nature, sexual propositions or threats. Non-verbal conduct such as displays of sexually, suggestive objects or pictures, jeering, whistling or obscene gestures. Insults, slurs or ridiculing relating to race, color, sex, age, national origin, religion, handicap, marital status or disability. Because of AMERISEARCH STAFFING strong disapproval of offensive or inappropriate behavior at work, all workers and employees must avoid any action or conduct that could be viewed as harassment of any kind. Any worker or employee who has a complaint of harassment about anyone, including supervisors, co-workers or visitors should immediately notify the office branch manager or president of the company. All managers who are aware of harassment must report the harassment to the above people. AMERISEARCH STAFFING will take all reasonable precautions to keep confidential any such complaints about harassment, except as necessary to investigate the complaint or as required by law. AMERISEARCH STAFFING will not retaliate against any person because he or she reports illegal harassment. Complaints about harassment will be promptly and thoroughly investigated (by interviewing the complainant, the alleged harasser, and all witnesses) and remedied. AMERISEARCH STAFFING will take appropriate corrective action, including disciplinary measures when appropriate, to remedy all violation of this policy, up to and including discharge. Appropriate action will also be taken against violation of this policy by any non-employee. It is an employee’s right not to be subjected to harassment. AMERISEARCH STAFFING will not tolerate such behavior. I have read, understand and agree to abide by this policy.

ACKNOWLEDGMENT OF SAFETY RULES OF TRAINING
I have read (or had read to me) AMERISEARCH STAFFING safety rules and regulations contained in AMERISEARCH STAFFING General Safety Rules. I acknowledge that I understand these rules and I agree to follow them. When in doubt concerning safe job performance, I will speak to my immediate supervisor. Breaches of the safety rules will subject me to discipline up to and including denial of further work and termination.

MEDICAL AUTHORIZATION
The undersigned hereby authorized all health care providers to disclose and deliver to my employer AMERISEARCH STAFFING or its representatives all medical information and records in your possession that reflects my ability to perform strenuous physical tasks and all aspects of varied physical labor. I understand that AMERISEARCH STAFFING, without further authorization, may re-disclose said information to its legal counsel, insurers, experts or agents. This authorization is effective for thirty (30) days after the date it is signed. A photocopy, or exact reproduction, of this signed authorization shall have the same force and effect as this original.

DRUG AND ALCOHOL TEST/RELEASE TEST
I agree to take a drug and alcohol test if I have a worker’s compensation injury while your employee and authorize the release of said drug and alcohol test to any authorized representative of the employer.

CONSENT FOR DRUG AND ALCOHOL TESTING
It is the policy of AMERISEARCH STAFFING to maintain and provide drug-free temporary personnel. This policy restricts certain items and substances from being brought to or being present when working for AMERISEARCH STAFFING. The use, possession, sale, manufacture, distribution, dispensation, concealment, receipt, transportation, or being under the influence of, or having detectable levels of, any of the following items or substances while working for AMERISEARCH STAFFING is prohibited:
• Illegal drugs, controlled substances, marijuana, intoxicants (legal or illegal), “look-alike” substances, designer drugs, counterfeit or synthetic drugs, inhalants, and any other drugs or substances that will, in any way, affect safety, work ability, alertness, coordination, judgment, response, or the safety of others on the job.
• Alcoholic beverages, except as specifically authorized by AMERISEARCH STAFFING Management.
• Drug paraphernalia.
• Prescription drugs and over-the-counter medications except those which have been legally prescribed and taken in the prescribed dosage.
I agree to take a drug test which will be required after each and every on-the-job injury requiring treatment from a physician or following a serious or potentially serious accident or incident. I also understand I may be required to submit to a drug test if AMERISEARCH STAFFING Management believes or suspects I may be under the influence of a drug(s). I understand that the business which I am assigned to may ask that I submit to drug and/or alcohol testing. I consent to have specimens of my blood and urine tested for the presence of alcohol, marijuana, cocaine, heroin, codeine and other opiates; valium, Librium and other benzodiazepines; Nembutal, seconal, amytal and other barbiturates, PCP, amphetamines, Quaaludes, and any other controlled substance. I understand that I may not be eligible for employment at some facilities that utilize employees of AMERISEARCH STAFFING if any specimen tests positive for any of the above substances (unless I have a doctor’s prescription for that drug that I disclose before the test). I understand that if any test is positive for the presence of a controlled substance or alcohol, and I do not have an appropriate prescription, I may be rejected by the facility which utilized employees of AMERISEARCH STAFFING. I understand and agree that if I fail or refuse to submit to such a test, I may be dismissed from my employment. I also understand and agree that any positive test may cause me to be dismissed from my employment. I release and hold harmless AMERISEARCH STAFFING and any business where I am place, and their respective officer, directors, shareholders, agents and employees from any and all claims, damages, or alleged liabilities arising from or related to: I) any decision not to rehire me, 2) any decision to dismiss me from employment, 3) the drug testing procedure, 4) the dissemination of information concerning the results of the test, and 5) any claim that the information from the test was inaccurate or defamatory.

RELEASE OF CRIMINAL RECORDS
I the undersigned do hereby authorized AMERISEARCH STAFFING to examine any and all criminal records and arrests on file. I understand that I am waiving my rights of confidentiality concerning my criminal history.

VEHICLE HOLD HARMLESS AGREEMENT
You arc agreeing that the use of your personal motor vehicle is entirely at your own risk, and you are releasing and agreeing to not hold AMERISEARCH STAFFING, or any of our customers liable for any damage that is caused to your vehicle during your time as an employee of AMERISEARCH STAFFING. Please advise the dispatcher if you have any questions concerning these requirements and we will attempt to find an employment opportunity that matches your specific abilities.
CERTIFICATION AND AGREEMENT
I hereby declare that all statements contained in this application arc true and correct and understand that false or inaccurate information in the application will be a basis for termination and rejection of this application. I hereby authorize AMERISEARCH STAFFTING to investigate my background and verify this information. I understand that if employed, my employment will not be for any fixed period of time and may be terminated by me or AMERISEARCH STAFFTING at any time. I also authorize AMERISEARCH STAFFTING to release the information contained herein and its findings and work history of my employment to other firms or person on request. I also understand and agree that I may be expected to work on a wide variety of job assignments at various pay levels depending on the assignment locations in the United States of America and agree to accept assignments for which I am qualified as they become available. I authorize investigation of all statements continued in this application. I understand that misrepresentation or omission of facts asked for is cause for refusal to place any applicant at any time without any previous notice. I authorize the investigation of all matters contained in this application and hereby give AMERISEARCH STAFFTING permission to contact previous employers, references, and others, and hereby release AMERISEARCH STAFFTING from any liability as a result of such contact. I understand that to be employed I must be authorized to work in the United States, and must provide documents to prove this. I certify that all of the information in this application is complete and accurate, and I agree to all of the terms and conditions recited in this document. Failure to abide by any or all items above may result in AMERISEARCH STAFFTING refusing to place me in any temporary job. I agree, waive, release and forever discharge any claim that I may now have or that my later develop against AMERISEARCH STAFFTING with respect to the above.

SIGNATURE DATE
  


Submit Your Application


Please CLICK 'SUBMIT YOUR APPLICATION' ONLY ONCE . Depending on your connection speed it may take a few seconds for your computer to cycle to the next screen. Please be patient, the system is processing the application. If you click this button more than once you run the risk of submitting multiple applications.