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 
Brookville
Clark County
Darke County
Dayton Suburbs East
Dayton Suburbs North
Dayton Suburbs South
Dayton Suburbs West
Fairborn
Franklin
Greene County
Miami County
Montgomery County
Piqua
Prebble County
Shelby County
Sidney
Springfield
Tipp City
Troy
Urbana
Vandalia
Warren County
Westbrook

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.
(Salary/Pay per hour: NOT REQUIRED in CA, DE, MA, OR, or NYC)

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 hereby authorize BarryStaff Inc. and all former employers, and others given by me as reference, to answer all questions and to give all information in connection with this application or in any way concerning me, and it is understood and agreed that any misrepresentation (including omission of information) by me in this application will result in cancellation of the application and/or immediate termination of employment with BarryStaff Inc. I agree, if employed by BarryStaff Inc., that if ever I make claims against you for personal injuries, upon your request I shall submit to drug screens and examinations by physicians of your selection. Your employment of me may be terminated by BarryStaff Inc. at any time without any liability to me except for wages and salary as have been earned by me at the date of such termination. I understand that it is my responsibility to notify you of my availability on a weekly basis at a minimum, and if I do not, I will be considered unavailable for work.
  


Submit Your Application


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