Skilled Staffing Job Application
Applicant's Information
Date of Application *
First Name *
Middle *
Last Name *
Present Address *
Apt. #
City *
State *
Zip Code *
Telephone *
Position Applying For
Preference ex. full time, part time, seasonal
Are you willing to work overtime as necessary?
Clear selection
Date Available
Only U.S. Citizens or aliens who have a legal right to work in the U.S. are eligible for employment. Can you, upon employment, submit documentation verifying your legal right to work in the U.S. and your identity? *
Have you ever pled guilty or “no contest” to, or been convicted of, a misdemeanor of felony?. If yes please explain *
Are you 18 years of age or older? *
Have you ever been employed by Skilled Staffing? If Yes, state dates of employment, location and position title: *
Have you ever been terminated or asked to resign from any job? If Yes, please explain circumstances and provide dates: *
Please explain any gaps in your employment history:
May we contact your employer? If No, please explain:
How did you hear about this position? (Please specify the name of the source, agency, etc.)
License/Certificate Number:
State & Exp Date:
Educational History
Name of the School
#Years Attended
Field of Study
Personal References
Provide us with (2) Personal References (Family or Friends)
(1)Name: *
Ref. Phone Number: *
(2)Name: *
Ref. Phone Number:: *
Employment Record
Provide us with (2) Professional References
First Reference
Company Name: *
Supervisor’s Name: *
Pay Rate:
Employer Full Address:
Tel: *
Work Performed:
Reason for Leaving:
Second Reference
Company Name:: *
Supervisor’s Name:: *
Pay Rate::
Employer Full Address::
Tel:: *
Work Performed::
Reason for Leaving::
Can you read Blueprints?
List your Skills
List your Skills
Please Select any TOOLS that you currently OWN
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