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First Name *

Last Name *

M.I. *

Date *

Street Address *

Apartment/Unit #

City *

State *

Zip *

Phone Number *

Email Address *

Date Available *

Social Sercurity No.

Desired Salary *

Position applying for/Type of position *

Are you a citizen of the United States? *

Yes No

If no are you authorized to work in the United States? *

Yes No

Have you ever worked for this company? *

Yes No

If yes enter start and end dates that you worked for this company

Do you have a valid drivers license? *

Yes No

Previous Employment

Company *

Phone Number *

Address *

Supervisor *

Job Title *

Starting Salary *

Ending Salary *

From *

To *

Reason for leaving *

May we contact your previous supervisor as a reference? *

Yes No

Company

Phone Number

Address

Supervisor

Job Title

Starting Salary

Ending Salary

From

Reason for leaving

May we contact your previous supervisor as a reference?

Yes No

Company

Phone Number

Address

Supervisor

Job Title

Starting Salary

Ending Salary

From

Reason for leaving

May we contact your previous supervisor as a reference?

Yes No

Education

High School *

Address *

From *

To *

Degree *

Did you graduate? *

Yes No

College

Address

From

Degree

Did you graduate?

Yes No

Other

Address

From

Degree / Certificate

Did you graduate?

Yes No

References

Full Name *

Relationship *

Company *

Phone Number *

Adress *

Full Name *

Relationship *

Company *

Phone Number *

Adress *

Full Name *

Relationship *

Company *

Phone Number *

Adress *

Success! Your application was submitted successfully!

I certify that my answers are true to the best of my knowledge.

I understand and agree that nothing contained in this employment application or in the granting of an interview creates an employment contract between Quaility Controlled Staffing Inc. and myself either employment or the providing of any benefit. If and eployment relationship is established, I understand that my employment will be terminable "at will," that I will have the right to terminate my employment at anytime, and that Quality Controlled Staffing Inc. will retain a similar right to terminate my employment at anytime.

No guarantee of employment for length of duration is made through this application process, it being expressly understood that any employment here is as a temporary employee assignable to companies as contract temporary employee.

I authorize this company, and authorize each request from formeremployer and person, firm or corporation give as reference to answer all questions that may be asked, and to give all information that may be asked, If i request I will consent to a drug and or alcohol test.

As an employee of Quality Controlled Staffing Inc. I hereby acknowledge and pledge to Quality Controlled Staffing Inc. that i will comply with all provisions relating to nondisclosure or use of any secret, confidential or proprietary information and know-how of Quality Controlled Staffing Incs's client compaines.

I Certify that the answers on the application are true and correct, I understand that if any of the answers are found to be wrong or incorrect, I could be subject to immediate dismissal.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

I Agree