QC STAFFING ONLINE APPLICATION FORM

QC Staffing is collecting this information for employment purposes only. QC Staffing will not sell, lease, or provide this information to anyone without applicant approval. Fields marked with an  *  are required.

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Personal Information

Social Security Number:  -   -	Alien Number:
First Name:*	Middle Initial:	Last Name:*

Address:    *

City:    * Barstow Bettendorf Blue Grass Carbon Cliff Cleveland Clinton Coal Valley Colona Cordova Davenport East Moline Eldridge Erie Hampton Hillsdale LeClaire Milan Moline Pleasant Valley Port Byron Rapid City Rock Island Silvis

State: * IA IL

Zip Code:    *

Home Phone:  *  -  -

Alt Phone:     -  -

Email: @ .com .net .org .edu .gov

Emergency Contact Name:*

Emergency Contact Phone:*  -  -

Emergency Contact Email: @ .com .net .org .edu .gov

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Education

Name of High School:  *

City:    *

State:    *

Graduate: * Yes No

Highest Grade: * 0 6 7 8 9 10 11 12

Completed GED:    Yes No

Trade School:	City:	State: (ex:IA)	Graduate: Yes No	Last Grade: 0 1 2 3 4
College:	City:	State: (ex:IA)	Graduate: Yes No	Last Grade: 0 1 2 3 4	Major:	Minor:
Graduate School:	City:	State: (ex:IA)	Graduate: Yes No	Last Grade: 0 1 2 3 4

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WORK HISTORY     (Begin with most  recent job)

MOST RECENT EMPLOYER

Employer:    *	Job Title:    *	Name of Supervisor:    *	Reference Phone:    *  -  -
Address:    *	City:    *	State: (ex:IA)   *	Zip Code:    *

Current Employer?:* Yes No

Start Month:    * January February March April May June July August September October November December

Start Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

End Month:    * January February March April May June July August September October November December

End Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Start Pay:   *

End Pay:   *

Duties:    *

Reason for Leaving:    *

PREVIOUS EMPLOYER 2

Employer:    *	Job Title:    *	Name of Supervisor:    *	Reference Phone:    *  -  -
Address:    *	City:    *	State:    *	Zip Code:    *

Current Employer?:* Yes No

Start Month:    * January February March April May June July August September October November December

Start Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

End Month:    * January February March April May June July August September October November December

End Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Start Pay:   *

End Pay:   *

Duties:    *

Reason for Leaving:    *

PREVIOUS EMPLOYER 3

Employer:    *	Job Title:    *	Name of Supervisor:    *	Reference Phone:    *  -  -
Address:    *	City:    *	State:    *	Zip Code:    *

Current Employer?:* Yes No

Start Month:    * January February March April May June July August September October November December

Start Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

End Month:    * January February March April May June July August September October November December

End Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Start Pay:   *

End Pay:   *

Duties:    *

Reason for Leaving:    *

PREVIOUS EMPLOYER 4

Employer:    *	Job Title:    *	Name of Supervisor:    *	Reference Phone:    *  -  -
Address:    *	City:    *	State:    *	Zip Code:    *

Current Employer?:* Yes No

Start Month:    * January February March April May June July August September October November December

Start Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

End Month:    * January February March April May June July August September October November December

End Yr: * 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Start Pay:   *

End Pay:   *

Duties:    *

Reason for Leaving:    *

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EMPLOYMENT SKILLS

OFFICE SKILLS

Typing WPM	Microsoft Word	Microsoft Excel	Microsoft Access
QuickBooks	Peachtree	Microsoft Publisher	Microsoft Outlook
Numeric Data Entry	Alpha Numeric Data Entry	Desktop Publishing	Inventory
Filing	Dictaphone	Shorthand	Receptionist
10-Key Calculator	Book Keeping	Collections	Posting
Payroll	Accounts Receivable	Accounts Payable	Tax Preparations

MARKET SPECIALIZATION

Paralegal

Insurance

Medical Terminology

Legal Terminology

GENERAL SKILLS

Cashier

Teller

Telemarketing

Bilingual

INDUSTRIAL SKILLS

OTHER SKILLS

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WORK PREFERENCE   

Check All Days Available:* Monday    Tuesday    Wednesday    Thursday    Friday    Saturday    Sunday

Check all Shifts Available:   * First Shift    Second Shift    Third Shift

Employment Desired:   * Temp Part Time Full Time

Work Type Desired:   * Maintenance Administrative Advertising Archetecture/Drafting Management Research Landscaping Cooking Barge Worker Billing Accounting Construction Computer Design Chemistry Custodial Clerical Computer Technician Consulting Correction Cashier Customer Service Driver Medial Office Editing Electrician Human Resources Public Works Librarian Law Enforcement Fabrication File Clerk Security Inspection Instructor Inventory Production Assembly General Laboror Liaison Line Worker Auditing Machinist Mail Courier Marketing Mechanic Mover Office Clerk Sales Painting Programmer Receptionist Registrar Secretarial Shipping/Receiving Tax Preparation Telemarketing Waiter/Waitress Welding

Hourly Wage Desired:   *

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EMPLOYMENT LIMITATIONS   

Are you 18 years or older?   * Yes No

Are you legally authorized to work in the US?   * Yes No

Do you have a valid Drivers License?   * Yes No

Do you have reliable transportation?   * Yes No

Type of Transportation   * Personal Vehicle Public Transportation Family or Friend

Are you currently a student?   * Yes No

How many hours are you enrolled?   * 0 1 2 3 4 5 6 7 8 9 10 11 12 More than 12

How did you hear about Quality Controlled Staffing?   * Internet Job Fair Employer Referal From a friend Other