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: 0001 SKILLED
 Algorithm Scientist
 CAD - Computer Aided
 Chemist
 CNC Programmer
 Graphic Design
 IT-Information Tech
 Lab Technician
 Panel Wiring
 Powder Coater
 Printing Press
[Collapse]Skill Set: 0011 SKILLED, CONT.
 Purchasing
 Quality Assurance
 Ruler Measurements
 Safety Manager
 Silkscreen
 Technical Writer
 Video, Film, & Edit
 Website Development
[Collapse]Skill Set: 0021 SERVICE
 Bartender
 Child Care
 Cook
 Cosmetology
 Event Planner
 Event Staff
 Food Server
 Lifeguard
 Retail
 Security Officer
[Collapse]Skill Set: 0031 DEGREE
 Degree GED/Diploma
 Degree Trade School
 Degree Associates
 Degree Bachelors
 Degree Masters
 Degree Doctorate
[Collapse]Skill Set: 0041 ENGINEERING
 Engineer Biomedical
 Engineer Chemical
 Engineer Civil
 Engineer Electrical
 Engineer Electromech
 Engineer Environment
 Engineer Industrial
 Engineer Mechanical
 Engineer Software
[Collapse]Skill Set: 0051 MEDICAL
 Medical Assistant
 Medical Billing
 Medical CNA
 Medical HHA
 Medical LPN
 Medical RN

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:
               
      I certify that the information on this application is true and factual
  


Submit Your Application


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