Anderson-Staffing - Application Form
  Social Security # Today's Date: 
First: Int: Last:
Address:
City: State: Zip:
Phone:
Phone Voice Mail Cell Message Other
Alternate Phone:
Phone Voice Mail Cell Message Other
 
Minimum hourly rate you would accept. $: How long are you available to work? Start: Until:
Days Available for Work:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Shifts / Hours Preferred:
Day Swing Graveyard 8 Hours 10 Hours 12 Hours
Transportation: Vehicle Bus Ride Bike Are you Bilingual? Yes No Language:
What Type of Position are you Applying for?
1. 2. 3.
Type of Work would you accept? Full-Time Part-Time Preferred Work Pace? Fast Moderate Slow
Are you Interested in Temp-to-Hire Position? Yes No Are you Interested in Temporary Position?
1-2 days
2-4 weeks
2-6 months
1 year
Why are you seeking Temporary Employment?
Will you accept same day assignments? Yes No Are you available evenings? Yes No Are you available weekends? Yes No
Preferred Work Locations:
1. 2. 3.
Any awards, certifications, licenses or special registrations you have received:
Emergency Contact Name: Phone:
Have you ever worked for another temporary service? Yes No if yes, what service(s)?
Have you even worked for our organization? Yes No if yes, when?
Have you even been supervisor Yes No if yes, how many people have you supervised?
Are 18 or older? Yes No Can you present proof of legal right to work here in the USA? Yes No
Have you been convicted of felony? Yes No If yes, state the nature of offense(s),date of conviction, and probation restriction in the space below
Date of Conviction Restriction
 
    Previous Employment History
Date Salary
Company Name: Industry:
From:
Start:
Address:
To:
Final:
City: State: Zip:
Title:
Work Performed:
   
Reason for Leaving:
Supervisor:
Phone:
Date Salary
Company Name: Industry:
From:
Start:
Address:
To:
Final:
City: State: Zip:
Title:
Work Performed:
   
Reason for Leaving:
Supervisor:
Phone:
Date Salary
Company Name: Industry:
From:
Start:
Address:
To:
Final:
City: State: Zip:
Title:
Work Performed:
   
Reason for Leaving:
Supervisor:
Phone:

I understand it is my responsibility to follow this safety guidelines and procedures as well as those of the client(s) with whom I will be placed on assignment. Violation of these safety rules could endanger myself or others. I understand that I will not perform any task that I have not been trained or authorized to do or that I feel is unsafe. Initialed below, and agree to abide by these policies. I also understand that if I do not abide by these company policies and procedures, I could be taken off my assigned

Please initial next to each topic and sign below.

-You are employed by Anderson Staffing and Payroll, LLC. You must communicate with us regarding all jobs related issues.

-Safety is our number one priority. You must report all injuries to us, as well as unsafe work conditions.

-To stay active with our service, you must call in available every 14 days. Failure to do so will cause your status to become a “Voluntary Quit”

-To maximize your employment chances, call Anderson Staffing and Payroll each morning that you are available to work.

-Timecards must be received by 5:00 PM on Monday to ensure payment on Friday. It is your responsibility to have your supervisor authorize your time.

-Contact us immediately if your assignment has ended. By communicating with us, we can find you work again.


Signature of Applicant _________________________            Date _____________________



My signature on this employment application authorizes Anderson Staffing and Payroll, LLC. (ASAP) to investigate all statements and information given on this application and to check professional and personal references. I authorize my present and former employers and all references to release, whether or not it is in their records. To ASAP any information requested by ASAP. I indemnity and hold harmless any person or entity forms all liability for any damage whatsoever for insuring this information. I understand and agree that ASAP reserves the right to at will employment in all cases; no employment contracts are allowed at any time implied otherwise ASAP is the common law employer of temporary employees. I understand and agree that my employment contracts are allowed at any time implied or completion of drug and alcohol evaluation and other physical ability evaluation and I agree to undergo said evaluations upon request by ASAP. If I am ever unable to perform my job duties because of a job related injury, I agree to immediately report to ASAP and perform modified work as assigned.

I understand and agree that falsification of information, misleading statements, misrepresentation, or omission of facts called for anywhere on this application or other employment related forms is cause of denial of employment, or if employed, cause for termination regardless of when discovered. I understand and agree that ASAP is my employer of record. As soon as my work assignment is completed, I agree to contact a supervisor at ASAP for a new assignment or it can be assumed ASAP does not discriminate among applicants or employees on the basis of race, color, age, sex, religion, national origin, marital or veteran status, the presence of medical condition or disability, or any other legally protected status. ASAP is not an employment agency.
Signature of Applicant _________________________             Date _____________________