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 
Chatham
Decatur
Jacksonville
Lincoln
Pawnee
Petersburg
Riverton
Rochester
Sherman
Springfield
Taylorville

Skill Title 
Yes 
[Collapse]Skill Set: 0001 GENERAL OFFICE DUTIES
 WORD PROCESSING
 DATA ENTRY/10-KEY
 TYPING
 FILING
 RECEPTION/PHONES
 SUPPLIES MGMT.
 MAIL PROCESSING
 CUSTOMER SERVICE
 INTERNET RESEARCH
 OTHER
[Collapse]Skill Set: 0011 OFFICE EQUIPMENT
 MULTI-LINE PHONES
 DESK TOP/PC
 MAC
 COPY MACHINE
 FAX MACHINE
 POSTAGE MACHINE
 SCANNING EQUIPMENT
 OTHER
[Collapse]Skill Set: 0021 OFFICE SOFTWARE
 MS ACCESS
 MS EXCEL
 MS WORD
 MS OUTLOOK
 MS POWER POINT
 MS PUBLISHER
 ADOBE ILLUSTRATOR
 ADOBE PHOTOSHOP
 OTHER
[Collapse]Skill Set: 0031 MEDICAL/DENTAL OFFICE
 ICD-9 CODING
 MED. TRANSCRIPTION
 CLAIMS PROCESSING
 MEDICAL BILLING
 PATIENT REGISTRATION
 HIPPA KNOWLEDGE
 APPT. SCHEDULING
 OTHER
[Collapse]Skill Set: 0041 LEGAL OFFICE
 LEGAL SECRETARY
 LEGAL TRANSCRIPTION
 PARALEGAL
 OTHER
 BILINGUAL
[Collapse]Skill Set: 0051 ACCOUNTING/BOOKKEEPING
 AP/AR
 PAYROLL PROCESSING
 GENERAL LEDGER
 TAX RETURNS
 COLLECTIONS
 QUICKBOOKS
 PEACHTREE
 SAGE
 MAS 90
 OTHER

Enter as much information as you can. More details will help us better serve you.
(Salary/Pay per hour: NOT REQUIRED in AL, CA, CO, CT, DE, HI, IL, MA, ME, NJ, NY, OR, VT, WA)

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:
               
      I certify that I completed this application and that the information I have provided is true and accurate. Applications must be filled in completely to be considered for employment.
  


Submit Your Application


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