Employee Application
Last 4 numbers of your SSN:
*First Name:
Middle Initial:
*Last Name:
* City:
* State:
* 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:
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:
* What position are you applying for:
Date available for work:
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:
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:
Booneville, MO
Centralia, MO
Chesterfield, MO
Columbia, MO
Desoto, MO
Earth City, MO
Edwardsville, KS
Elberfield, IN
Evansville, IN
Fenton, MO
Ferguson, MO
Fulton, MO
Grandview, MO
Granite City, MO
Hannibal, MO
Haubstadt, IN
Huntingburg, IN
Independence, MO
Jefferson City, MO
Kansas City, KS
Liberty, MO
Louisiana, MO
Memphis, TN
Mexico, MO
Moberly, MO
Monroe City, MO
Montgomery City, MO
Mount Vernon, IN
Newburgh, IN
North Kansas City, MO
O'Fallon, MO
Oakland City, IN
Olathe, KS
Olive Branch, MS
Overland Park, KS
Perry, MO
Petersburg, IN
Platte County, MO
Princeton, IN
Richmond, MO
Shelby, MO
St. Ann, MO
St. Charles, MO
St. Joseph, MO
St. Louis, MO
St. Peters, MO
Troy, MO
Vincennes, IN
Washington, IN
Wentzville, MO

Skill Title 
[Collapse]Skill Set: 0010 DRIVER
 Tractor Trailer
 Delivery Truck
 Delivery Van
[Collapse]Skill Set: 0010 EQUIPMENT
 Outside Forklift
 Nail Gun
 Jack Hammer
[Collapse]Skill Set: 0010 MAINTENANCE
 Building Repair
 Machinery Repair
 Hotel Cleaning
[Collapse]Skill Set: 0010 SKILLED
 Road Crew
 General Labor
[Collapse]Skill Set: 0010 SUPPLIES AVAILABLE
 Hard Hat
 Safety Glasses
 Steel Toe Work Boots
 Fluorescent Vest
[Collapse]Skill Set: 0010 WAREHOUSE
 Computer Skills
 Hand Jack
 Stand Up
 Sit Down
 Cherry Picker
 Order Selector
[Collapse]Skill Set: 0999 FACTORY
 Mechanical Assembler
 Electronic Assembler
 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:
Name of employer:
City, State, Zip:
Job Position:
Pay per hour:
Reason for leaving:

Previous Employment #2

Dates of employment: From: To:
Name of employer:
City, State, Zip:
Job Position:
Pay per hour:
Reason for leaving:

Previous Employment #3

Dates of employment: From: To:
Name of employer:
City, State, Zip:
Job Position:
Pay per hour:
Reason for leaving:

Previous Employment #4

Dates of employment: From: To:
Name of employer:
City, State, Zip:
Job Position:
Pay per hour:
Reason for leaving:

Temporary Employment

FIRM # 1

FIRM # 2

Firm name:
City, State, Zip:
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:
City, State, Zip:
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:
      Policy Statement
Assignment Attendance: Once you are put on assignment by AmeriStaff, Inc., you are expected to fulfill the obligations set forth for that assignment. Your first 90 days of employment are considered a probationary period. Therefore, you are not allowed absences. Good attendance is mandatory during this period. Any employee who No Call, No Show, walks off a job, or quits without notice to AmeriStaff, will be deemed to have abandoned the assignment and will be subject to disciplinary action which includes the following: your weekly wage will drop to $8.60 (MO), $7.25 (IN), $7.25 (KS)/ hour. You must give us 24 hour notice if you choose to be eligible for rehire through AmeriStaff, Inc. If there is an emergency during this time and you are unable to go to work, you must contact both AmeriStaff, Inc. and the company you have been assigned with. This must be done 2 hours before your shift is scheduled to start.
Timecards: Once you have been placed with a job assignment the client will send Ameristaff your hours each week. It is a good idea to keep track of the hours you work in the event there is a payroll error. You will need to document the date and the time you started & ended your shift.
Pay Day: Payday is on Thursday of every week. If payday falls on a holiday, you will be paid the day before. Ameristaff offers two ways to receive your paycheck, either Direct Deposit or a Pay Card.
Injury at the worksite: Injuries at the workplace are a very serious matter to AmeriStaff, Inc. and the companies we work with. If you are injured at work, you must report your injury to your supervisor immediately. This needs to be done whether or not you believe it will require any kind of medical attention, because it may in the future. You also need to contact AmeriStaff, Inc. immediately. We have specific doctors and hospitals that we use. If you go to anyone else for medical attention, it will negate the claim.
Drug Policy: AmeriStaff, Inc. is a drug free work environment. Upon accepting an assignment to a specific company you may be administered a drug screen. If you refuse to submit for testing or fail any drug screen you will be immediately terminated and you will not be eligible for rehire.
Employment Relationship: The relationship between AmeriStaff, Inc., and our candidates or employees can be a mutually beneficial relationship, but it requires each employee and candidate to continually stay in touch with our AmeriStaff, Inc., office in order for us to have updated contact and availability information.

I understand that I may be required to work various assignments throughout the course of my employment. I further understand that the hours, days, salary, and type of work may vary. I understand and agree that as an employee I will contact AmeriStaff, Inc., at the end of an assignment to request an additional assignment. I understand that failure to contact AmeriStaff, Inc. within 24 hours of the completion of an assignment will be considered a voluntary resignation. I also have been informed that failure to contact AmeriStaff, Inc., within 24 hours will have an adverse effect on unemployment benefits. I have provided AmeriStaff, Inc., Inc. with any limitation I have that would prevent me from accepting assignments.

I have read and understand the above statements, and I acknowledge the following of these policies as a condition of my employment with AmeriStaff, Inc.
Equal Employment Opportunity: AmeriStaff, Inc. offers fair and equal employment opportunity for everyone, including protection from workplace harassment, regardless or race, color, sex, age, national origin, religion, handicap or disability. We recruit, process, and assign all applicants on the basis of their qualifications for the particular job, and we do so without regard to any factor unrelated to their ability to fulfill the job requirements. AmeriStaff, Inc. offices may only accept customer requests for temporary and permanent help which meet these standards.
To comply with the applicable laws ensuring equal employment opportunities to qualified individuals with a disability, we will make reasonable accommodations for the known physical or mental limitations of an otherwise qualified individual with a disability who is an applicant or employee, unless undue hardship would result.
Protection from Unlawful Harassment, Including Sexual Harassment: AmeriStaff, Inc. has a firm policy prohibiting unlawful harassment, including sexual harassment. This policy covers harassment in any form, including verbal, physical, or visual harassment. Sexual harassment is defined as unwelcome sexual advances or requests for sexual favors and other conduct of a sexual nature where:
1) Submission to such conduct is a term or condition of employment.
2) Submission to, or rejection of, the advance is used as the basis for making employment decisions.
3) Such conduct interferes with an individual’s work performance or creates an intimidating, hostile, or offensive working environment.
Employees who violate this policy are subject to disciplinary action, including discharge. Employees who have been subjected to harassment are urged to immediately report such incidents to their AmeriStaff, Inc. supervisor. False accusations will result in the same disciplinary action applicable to the one guilty of harassment. AmeriStaff, Inc. also prohibits harassment on account of race, color, age, national origin, religion, or disability.
Safe Workplace Environment: AmeriStaff, Inc., its customers and employees share in the responsibility of maintaining a safe work environment. Employees must follow all safety procedures and wear personal protective equipment as instructed. All employees are required to notify their AmeriStaff, Inc. office immediately if given an unsafe task or if they feel they have not been given the necessary training. Safety orientations provided via video orientation as well as written instructions. Additional information, including safety training at the job site and specific information regarding Material Safety Data Sheets (MSDS) covering known chemical exposures is to be provided by the job-site supervisors as needed. In the event of an injury or illness that arises from working on the job, all employees must notify their AmeriStaff, Inc. supervisor within 24 hours. All workers’ compensation injuries are treated at AmeriStaff, Inc. designated medical facilities, and each injured employee will be drug tested during the initial medical treatment. Unauthorized treatment will not be covered by AmeriStaff, Inc. or its insurance carrier.

Authorization to Release and Receive Information
As part of our normal procedures for processing applications, we may wish to perform a routine inquiry into your background. This information typically concerns an applicant’s character, general reputation, reliability, responsibility and honesty.

In connection with my application for employment, I hereby authorize AmeriStaff, Inc. to make inquires either by written communication, telephone, or in person to any former employer, governmental agency, school, credit bureau or law enforcement agency as to my records, documents or other information concerning my background.

I hereby authorize AmeriStaff, Inc. to forward all information concerning my background to potential companies for employment.

I release AmeriStaff, Inc. and it’s agents from any and all liability, including acts of negligence by AmeriStaff, Inc., and responsibility, damages and claims of any kind whatsoever arising from the disclosure of my background. I specifically waive my confidential relationship of privacy which may exist and completely release AmeriStaff, Inc.

I agree and understand that a photocopy of this authorization may serve as an original. I AGREE TO THESE CONDITIONS. YES


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