Street Address City State Zip Code

Date Available to Interview Date Available to Work

How Did You Hear Of Us?

What Shifts Will You Work? Day(1st) Evening(2nd) Night(3rd)

What Days Will You Work? M T W TH F SA SU

Hours Available To Work

Are You Available For Same Day Assignments? Yes No

Are You Available For Long Term Assignments? Yes No

Are You Available For Short Term Assignments? Yes No

Describe

Have You Ever Worked For A Temporary Agency? Yes No

Which Ones?

Are You Seeking Permanent Work? Yes No

Drivers License? Yes No

Education

High School Location Last Year Completed Freshman Sophomore Junior Senior

Degree

College Location Last Year Completed Freshman Sophomore Junior Senior

Degree

Other Location Last Year Completed Freshman Sophomore Junior Senior

Degree

Employment History

Employer Address Telephone Number

Dates Employed

From To

Hourly Rate

Starting Final Position Supervisor

Work Performed

Reason For Leaving

Employer Address Telephone Number

Dates Employed

From To

Hourly Rate

Starting Final Position Supervisor

Work Performed

Reason For Leaving

Employer Address Telephone Number

Dates Employed

From To

Hourly Rate

Starting Final Position Supervisor

Work Performed

Reason For Leaving

Employer Address Telephone Number

Dates Employed

From To

Hourly Rate

Starting Final Position Supervisor

Work Performed

Reason For Leaving

INDICATE INDUSTRIAL SKILLS AND YEARS OF EXPERIENCE

LIGHT INDUSTRIAL ASSEMBLY

FABRICATION

MACHINE OPERATION

QUALITY CONTROL SYSTEMS

MAINTENANCE

WELDING

SKILLED TRADE

CONSTRUCTION

TRUCK DRIVING

WAREHOUSE

AUTO REPAIRS/SERVICES

FOOD SERVICE

SOFTWARE

DESIGN SOFTWARE

BANKING EXPERIENCE

INSURANCE EXPERIENCE

SALES EXPERIENCE

ACCOUNTING/BOOKKEEPING

MEDICAL

SECRETARIAL

DATA ENTRY

GENERAL OFFICE SKILLS