Application for Employment

Date:
Social Security Number:
Your name*:
Address*:
Email Address:
Home Phone*:
Position Applying for:
Referred By:
Cell Phone*:
Desired Salary:
Date available to start*:
Are you able to work on weekends?:
Employment Desired: Full TimePart TimeTemporary
Shift Desired: 1st2nd3rd
Are you willing to travel? YesNo
What will be your means of transportation to work?
Notes:

Education

Highschool

Name*:
Location*:
Completed? YesNo
GED or Diploma? GEDDiploma

College

Name:
Location:
Completed (years):
Major/Degree:

Trade School

Name:
Location:
Completed (years):
Major/Degree:

Please list all work experience for the past seven years beginning with your more recent job held.

Name of employer*:
Position held*:
Address:
City, State, Zip Code*:
Rate of Pay:
Supervisor:
From*:
To*:
Reason for leaving:
Job Duties:


Name of employer:
Position held:
Address:
City, State, Zip Code:
Rate of Pay:
Supervisor:
From:
To:
Reason for leaving:
Job Duties:


Name of employer:
Position held:
Address:
City, State, Zip Code:
Rate of Pay:
Supervisor:
From:
To:
Reason for leaving:
Job Duties:

I certify the information I have provided on this application is true, correct and complete. I understand that false or incomplete information on this application may result in my ineligibility for employment with Premier Staffing, Inc.

Signature of Applicant*:
Date*: