GreatStaff Online Application

GreatStaff Solutions, LLC is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, disability, or any other status protected by law or regulation. It is our intention that all qualified applicants be given equal opportunity and that selection decisions be based on job-related factors.

APPLICANTS WILL BE TESTED FOR DRUGS AND CONTROLLED SUBSTANCES

* indicates required field

Date *

First Name *

Middle Name

Last Name *

Nickname

Street Address *

City *

State *

Zip Code *

Home Phone Number

Cell Phone Number *

E-mail Address *

Emergency Contact Name *

Relationship with Emergency Contact *

Contact Phone Number *

Referred by:

Date of Birth *

Have you had Temporary experience?

Yes

No

Have you ever been convicted, or plead guilty, of any crime (other than a minor traffic violation)? *

Yes

No

If Yes, explain by giving the nature of the offense and the date of your sentence, parole, probation, deferred adjudication or supervised release ended.
(Each instance will be considered in relation to the position for which you are applying.)

Desired Position:

First Date Available? *

Last Date Available?

Hours Preference? (hours/week)

Desired Salary? (per hour)

Minimum Salary? (per hour) *

Maximum travel distance one way?

Is Overtime Ok?

Yes

No

Restrictions?

Layoff/Recall

Student

None

Details?

Transportation?

Car Always Avail.

Carpool

Other

Other:

Required Notice?

Same Day

1 Day

More than 1 Day

Not Applicable

Assignment Duration?

Long or Short Term

Long Term

Short Term

Not Applicable

Available Days/Shifts Preference:
(place an X in the appropriate boxes)

1st Shift
Mon

2nd Shift
Mon

3rd Shift
Mon

Not Available
Mon

1st Shift
Tue

2nd Shift
Tue

3rd Shift
Tue

Not Available
Tue

1st Shift
Wed

2nd Shift
Wed

3rd Shift
Wed

Not Available
Wed

1st Shift
Thu

2nd Shift
Thu

3rd Shift
Thu

Not Available
Thu

1st Shift
Fri

2nd Shift
Fri

3rd Shift
Fri

Not Available
Fri

1st Shift
Sat

2nd Shift
Sat

3rd Shift
Sat

Not Available
Sat

1st Shift
Sun

2nd Shift
Sun

3rd Shift
Sun

Not Available
Sun

EDUCATION

Please List your two most recent, including High School, GED, Trade School or College

INSTITUTION 1 - Name *

City

State

Was Certification/Diploma/Degree attained? *

Yes

No

If so, please specify:

Major/Minor Course of Study, if applicable:

INSTITUTION 2 - Name

City

State

Was Certification/Diploma/Degree attained?

Yes

No

If so, please specify:

Major/Minor Course of Study, if applicable:

WORK EXPERIENCE

(list most recent employer first)

EMPLOYER 1 - Name *

City

State

Phone Number

May we contact for reference?

Yes

No

Job Title *

Job Description *

Reason for leaving *

Start Date *

End Date *

Salary or Hourly Pay *

Employment Type

Full-time

Part-time

EMPLOYER 2 - Name

City

State

Phone Number

May we contact for reference?

Yes

No

Job Title

Job Description

Reason for leaving

Start Date

End Date

Salary or Hourly Pay

Employment Type

Full-time

Part-time

EMPLOYER 3 - Name

City

State

Phone Number

May we contact for reference?

Yes

No

Job Title

Job Description

Reason for leaving

Start Date

End Date

Salary or Hourly Pay

Employment Type

Full-time

Part-time

SIGNATURE

The information I have provided on this form is true and complete. I understand that providing incorrect, false, or misleading information to the company will result in the cancellation of this application and refusal of employment.
If I am employed by GreatStaff Solutions, LLC., I understand that such employment will be on an "employee at will" basis, which means that I and GreatStaff, LLC are free to terminate my employment at any time, with or without prior notice, except as may be required by law.
I agree to be tested for the detection of drugs and controlled substances.
If offered a position, and requested by GreatStaff Solutions, LLC., I will submit to a physical examination.
If I am hired, I understand that I am required to provide proof of identity and legal work authorization.
You may obtain information about my character, reputation, personal characteristics, criminal history, and financial responsibility to help evaluate me as a prospective employee.
I understand that as a condition for GreatStaff Solutions services, some clients (i.e. employers) may require additional information relevant to a particular job assignment and may require copies of certain information obtained. I authorize GreatStaff Solutions to make inquires of my previous employers, educational institutions, personal acquaintances and references about these matters through personal interviews, or other means, if required by a GreatStaff Solutions client to provide such information to them.
I agree to resolve any dispute, claim or controversy that may arise between myself and GreatStaff Solutions, LLC. Regarding failure to be hired or termination of employment exclusively in accordance with GreatStaff Solutions LLC's Resolution Policy, including mediation and binding arbitration of such disputes.

I have fully read and completely understand the foregoing and seek employment under the conditions specified.

Applicant Signature *

Date Signed *

GreatStaff Employment Application

EDUCATION

WORK EXPERIENCE

SIGNATURE