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 
1Flexible
2Walking Distance
3Local Only
Aliquippa
Allison Park
Apollo
Aspinwall
Beaver
Beaver Falls
Belle Vernon
Blairsville
Blawnox
Boyers
Brookville
Bus Route
Butler
Cabot
Carnegie
Charleroi
Cheswick
Chicora
Connellsville
Cranberry Twp.
Delmont
East Brady
East Butler
East Pittsburgh
Edgewood
Ellwood City
Etna
Evans City
Export
Fairmont City
Fombell
Ford City
Forest Hills
Freedom
Freeport
Gibsonia
Glenshaw
Greensburg
Greentree
Grove City
Harmarville
Harmony
Hawthorn
Indianola
Irwin
Jeannette
Karns City
Kittanning
Latrobe
Leechburg
Leetsdale
Lower Burrell
Loyalhanna
Lyndora
Manor
Manorville
Mars
Mayport
McKeesport
Middlesex
Monroeville
Mt. Pleasant
Murrysville
Natrona Heights
New Bethlehem
New Castle
New Kensington
New Stanton
North Hills
North Huntington
North Versailles
Norvelt
Oakland
Oakmont
Penn Hills
Petrolia
Pittsurgh
Plum
Portersville
Renfrew
Ridc Park
Rimersburg
Route 910
Ruffsdale
Sarver
Saxonburg
Scottdale
Seminole
Seven Fields
Sewickley
Sharpsburg
Sligo
Slippery Rock
Smithton
Springdale
Strattonville
Swissvale
Tarnetum
Templeton
Trafford
Turtle Creek
Uniontown
Vandergrift
Venus
Verona
Wexford
Worthington
Youngwood
Zelienople

Skill Title 
Yes 
[Collapse]Skill Set: 0010 DRIVER
 License
 CDL-A
 CDL-B
 CDL-C
 Tractor Trailer
 Delivery Truck
 Delivery Van
 Automatic
 Clutch
[Collapse]Skill Set: 0010 EQUIPMENT
 Backhoe
 Bulldozer
 Outside Forklift
 Crane
 Drill
 Saw
 Nail Gun
 Jack Hammer
[Collapse]Skill Set: 0010 MAINTENANCE
 Building Repair
 Machinery Repair
 FloorCare
 Landscape
 Lawncare
 Hotel Cleaning
 Janitorial
[Collapse]Skill Set: 0010 SKILLED
 Welder
 Machinist
 Demolition
 Supervisor
 Carpenter
 Construction
 Plumber
 HVAC
 Electrician
 Mechanic
 Painter
 Flagger
 Mover
 Laundry
 Road Crew
 Digger/Raker
 General Labor
 Milwright
 Concrete
[Collapse]Skill Set: 0010 SUPPLIES AVAILABLE
 Hard Hat
 Tools
 Safety Glasses
 Steel Toe Work Boots
 Fluorescent Vest
 Gloves
[Collapse]Skill Set: 0010 WAREHOUSE
 Computer Skills
 Receiving
 Shipping
 Load/Unload
 Hand Jack
 Forklift
 Stand Up
 Sit Down
 Cherry Picker
 Inventory
 Order Selector
[Collapse]Skill Set: 0999 FACTORY
 Mechanical Assembler
 Electronic Assembler
 Solderer
 Inspector
 Picker/Packer
 Quality Control
 Machine Operator
 Production Line
 Production Cell
 PC Board Assembler

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 the information on this application is true and factual
  


Submit Your Application


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