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Application

Please fill in all the requested information.

Name: (First, middle, last)
SSN (optional):
Address:
City, State Zip:	,
County:
Primary Phone:	Home Cell Parents Other
Alternate Phone:	Cell Home Parents Other
E-mail:
Birth date (optional):
Do you have your own transportation?	Yes No
Emergency Contact:
Name:
Relationship:
Phone Number:
Preferences:
Position Desired:
Minimum acceptable pay rate/hour:
Current pay rate/hour:
Smoking Preference:	Flexible Nonsmoking Smoking
Acceptable locations:
Appleton Chilton Eau Claire Manitowoc Stevens Point Neenah/Menasha Hilbert/Brillion Chippewa Falls Two Rivers Plover Kaukauna New Holstein Menomonie Fond du Lac Wisconsin      Rapids Weyauwega Kiel   Ripon New London Plymouth   Waupun   Any of above Any of above   Lomira
How did you hear about Flex-Staff?
Most Recent Education:
Start and End Dates:	through
School:
Location:
Degree Received:	Associate Bachelor Arts Bachelor Science Certificate General Education High School Masters No High School Diploma Some College
Most Recent Employment Experience:
Start and End Dates:	through
Starting Salary:
Ending Salary:
Company Name:
City and State:	,
Reason for leaving:
Supervisor Name:
Supervisor Phone:
Please check this box if it is ok for us to call this contact for references.
Job Title/Duties:
Previous Employment Experience:
Start and End Dates:	through
Starting Salary:
Ending Salary:
Company Name:
City and State:	,
Reason for leaving:
Supervisor Name:
Supervisor Phone:
Please check this box if it is ok for us to call this contact for references.
Job Title/Duties:
Previous Employment Experience:
Start and End Dates:	through
Starting Salary:
Ending Salary:
Company Name:
City and State:	,
Reason for leaving:
Supervisor Name:
Supervisor Phone:
Please check this box if it is ok for us to call this contact for references.
Job Title/Duties:
Other Work Experience:
Applicant Statement:
I hereby authorize any of the persons or organizations referenced in this application to provide Flex-Staff with information they might have, personal or otherwise, with regard to any of the subjects covered in this application and release all such parties from all liability or damages that may result from furnishing such information to Flex-Staff. I understand that Flex-Staff may require a criminal background check or credit report. I understand that Flex-Staff may require a medical examination including, but not limited to drug screening at any time after employment. I acknowledge that if employed by Flex-Staff this is an at-will employment relationship which may be terminated at anytime by Flex-Staff or myself. I agree that I will not seek or accept employment from a Flex-Staff customer to whom I have been assigned for at least 90 days after the last day of my assignment or within 6 months of my referral to a Flex-Staff client without prior approval from Flex-Staff. I understand that I am to contact the Flex-Staff office within one working day after completing each assignment to discuss another assignment. If I fail to do so, Flex-Staff may assume that I have voluntarily quit. If I accept a position on the payroll of the Flex-Staff customer to which I was assigned, I am voluntarily terminating my employment with Flex-Staff. The information given by me on this application is true to the best of my knowledge. Any false statements on this application will be grounds for termination.
I AGREE (required) DATE: (required)