Employee Application
Last 4 numbers of your SSN:
Salutation:
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*First Name:
Middle Initial:
*Last Name:
Nickname:
Address:
* City:
* State:
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* 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:
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* What position are you applying for:
Date available for work:
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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 
No data to display

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:
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v
Name of employer:
Address:
City, State, Zip:
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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:
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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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