Employment Application - peopleSource

We offer equal employment opportunities to all persons without regard to race, color, religion, age, marital or veterans' status, sex, national origin, disability, or any other legally protected status.

application for employment

First Name: Middle Initial:	Last Name:
Address: City: State: Zip Code:
Home or Nearest Phone:	Emergency Phone Number:
Cell Phone:	Emergency Name:
Email Address:	Work Area(City or Town):
Are you over the age of 18?: Yes No	How soon will you be available to work?:
Type Transportation to and from work? Car Bus Bike Walk Other
Type of employment seeking? Full Time Part Time Temporary Direct Hire
Rate of Pay Preferred?	Minimum Rate of Pay?
Days available? M T W Th F Sa Su	Weekends? Yes No Overtime? Yes No
Hours available? From AM PM To AM PM

Education

Type of School	Name and Address of School	Courses Majored In	Last year completed	Graduate?
High School
College				If yes, give degree

background information

Do you speak Multiple Languages? No Yes If so, what language(s)?

How did you hear about us?

Have you applied for a job with us before? No Yes If so, when?

Have you ever worked for us before? No Yes If so, where?

Have you ever been convicted of or pled guilty or "no contest" to a felony? No Yes

If so, state offense, date, court and place where conviction occurred.

NOTE: Conviction of a felony does not automatically disqualify an applicant for employment.

Are you employed now? Yes No If so, is your employer a staffing service? Yes No

Have you worked with another temporary service? No Yes If so, where assigned?

Why do you desire to make a job change? Supplemental Income Between Jobs Gain Experience Seeking Full Time Increase Skills Student Laid Off

Upload your Resume or listing of previous work experience.

Please read the following certification carefully before submitting this application:

I certify the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient reason for denial of employment or discharge.  I authorize the use if any information in this application to verify my statements, and, except as indicated above, I authorize the past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous education or employment record.  I release all such persons from any liability or damages on account of having furnished such information.  I consent to such investigations as PeopleSource may make regarding driving records, law enforcement records, credit reports and my general background.  I further understand that all applicable portions of this application must be completed or I will be ineligible for consideration for the position for which I am applying.
			
I understand that nothing contained in this employment application or in the granting of an interview or of a position of employment is intended to create an employment contract between PeopleSource and myself for either employment or for providing any benefits.  No promises regarding employment have been made to me, and I understand that no promise or guarantee of employment for any specific length of time or under any specified circumstances shall be binding upon PeopleSource unless made in writing by or with the express written consent and authorization of President.  If am employment relationship is established, I understand that I have the right to terminate my employment at any time and for any reason and that PeopleSource retains the same right.

I understand that, depending on the position applied for, prior to being offered employment with PeopleSource I may be requested to take an examination pertaining to skills or equipment operation.  In the event I have disability which will affect my ability to take the test, I will so inform PeopleSource prior to the test so that a reasonable accommodation can be made.  Requested accommodations may include accessible testing sites, modified testing conditions, and accessible testing formats. PeopleSource reserves the right to require medical documentation concerning the need for the accommodation.

I understand that, if I am initially offered a position of employment, PeopleSource may require me to pass a medical exam prior to the commencement of work and as a condition of employment.  I also understand that drug and/or alcohol tests are a condition of employment and that refusal to submit to such tests when asked by PeopleSource shall be considered sufficient reason for denial of employment or discharge.

I understand that if employed, the policies and rules which are issued by PeopleSource are not conditions of employment and that PeopleSource may revise policies or procedures, in whole or in part, unilaterally at any time.

I have read and understand the above certification.