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Job Information

Personal Information

First Name Middle Initial
Last Name
Date of Birth Social Security Num
Address Apt #
City State
ZIP Email
Day Phone Evening Phone
Marital Status Dependants

Education

High School Address
Dates Attended Studies
Graduate No       Yes Diploma No       Yes

College Address
Dates Attended Studies
Graduate No       Yes Diploma No       Yes

Work History

Desired Position
Date Available Desired Salary
How many years experience do you have in the position selected?
Have you been convicted or pled guilty to a felony? No       Yes
Have you ever had any worker comp injuries? No       Yes
Software Experience: Excel PowerPoint Word Quicken Quick Books Word Perfect

Please describe the position you are interested in:


Copy and Paste text of resume here.  If no resume available, please describe in detail your job history, education and references.

Previous Employment

Employer #1
Company Phone
Address Supervisor
Job Title Starting Salary
Ending Salary Responsibilities
From To
May we contact your previous supervisor for a reference? No       Yes
Reason for Leaving

Employer #2
Company Phone
Address Supervisor
Job Title Starting Salary
Ending Salary Responsibilities
From To
May we contact your previous supervisor for a reference? No       Yes
Reason for Leaving

Employer #3
Company Phone
Address Supervisor
Job Title Starting Salary
Ending Salary Responsibilities
From To
May we contact your previous supervisor for a reference? No       Yes
Reason for Leaving

Employer #4
Company Phone
Address Supervisor
Job Title Starting Salary
Ending Salary Responsibilities
From To
May we contact your previous supervisor for a reference? No       Yes
Reason for Leaving

References

Reference #1
First Name Last Name
Phone  

Reference #2
First Name Last Name
Phone  

Reference #3
First Name Last Name
Phone  

Reference #4
First Name Last Name
Phone  

Medical History Questionnaire (confidential)

In the past 2 years have you:
Experienced, been treated, or diagnosed with any mental, physical, or medical impairment that would prevent you from reasonably performing any job for A1 Staffing which you applied?      
Been operated on or a patient in a hospital?      
Been treated for neck or shoulder strain or pain?      
Been treated for back injury, strain, or pain?      
Been treated for high/low blood pressure?      
Received treatment or drugs, alcohol, or chemical substance?      
Had any ill effects from the type of work you do?      
Been injured on the job and required medical attention?      
Received medical disability payments?      
Been treated for asthma or other respiratory ailments?      
Which describes your current health? Excellent
Good
Fair
Poor

Conditions And Policies

A1 Staffing & Recruiting Agency Inc. is an equal opportunity employer committed to a policy of non-discrimination in employment on any basis, including race, color, sex, religion or national origin. You are not required by law to answer the following questions. On the other hand, the information will help A1 Staffing & Recruiting Agency help you find the employment of your preference.

I have read the A1 Staffing & Recruiting Agency policy & procedures.
I certify that my answers are true and complete with the best of my knowledge. I agree to A1 Staffing & Recruiting Agency Inc. to do a background investigation if possible. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release of A1 Staffing & Recruiting Agency Inc. Once applications are completed please call 405-787-7600 to schedule an appointment.

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Additional please post your resume at jobs@a1staffingok.com