Date
Job applying for
Last Name
First Name
Middle Initial
Email Address
Best Way to contact? Phone Email
Home Address: (No PO Box)
City
State
Zip Code
Home Phone
Cell Phone
Are you over 18 years of age? Yes No
Shift Desired 1st 2nd 3rd
Available for Overtime? Yes No
Length of assignment you will consider? Short Term Long Term Temp-to-Hire Direct Hire
Minimum Payrate?
Emergency Name & Phone #
Type of School
Name & Location
Mark Highest Level Completed
Major/Degree/GED
Did you Graduate?
High School
College
Other
Work History: List all positions in order, starting with last position first.
MAY WE CONTACT YOUR PRESENT EMPLOYER? Yes No If no, please explain:
Third Employer
Date Started
Date Ended
Name of Employer
Address of Employer
Rate of Pay (Start)
Rate of Pay (End)
Supervisor Name:
Supervisor Title:
Supervisor Phone#:
Reason for Leaving:
Second Employer
First Employer
Have you ever plead no contest/nolo/guilty to a crime or been convicted of a crime? Yes No (Note: Answering “Yes” does not constitute an automatic bar to employment.) If yes, please give dates and details:
I hereby affirm that the information provided on this application (and any resume submitted) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in dismissal if discovered at a later date.
I understand that completion of this application does not assure me of a position with H & H Staffing Services, Inc. I also understand that neither application nor any other document constitutes a contract of employment for a specific term and that any employment relationship that may be established will be “at will” and may be terminated at any time, with or without cause, by me or H & H Staffing. I understand that no representative of H & H Staffing has any authority to enter into any agreement for employment with me contrary to the foregoing.
I hereby authorize H & H Staffing to investigate all information pertinent to my application in order to determine my qualifications for employment. I hereby authorize all persons and organizations having information relevant to my application to provide that information to H & H Staffing and I hereby agree to hold harmless H & H Staffing and all those providing information to it from any liability arising out of or as a result of the provision or use of such information.
Your Initials:
