Contact InformationFirst Name*Last Name*Middle Initial*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code SS Number*This is required for our system to process your application.Phone Primary*Cellphone*Cellphone Carrier*Select carrier to receive textsAlaska CommunicationsAliantAmeritechAT&TAT+T MobilityBell Mobility & Solo MobileBellSouthBoost MobileComcelCricketH2O WirelessMetroPCSOpt OutSprintSprint(PCS)Straight TalkT-MobileTracFoneUS CellularVerizonVirgin MobileName of Emergency Contact*Emergency Contact Phone number*Email Address* Other InformationHow did you hear about Staffing Service USA?Do you have the legal right to work in the United States?*YesNoHave you ever been convicted of a felony, misdemeanor, or any other offense other than a minor traffic violation? If yes, please explain.*Convictions will not necessarily bar employment.Have you ever committed an offense involving dishonesty, breach of trust or fraud? If yes, please explain.*Have you ever been issued a security clearance? If yes, when/where?Have you ever completed an OSHA class? If yes, when/where?Work HistoryPlease provide a minimum of 5 years work history when possible. Start with most recent.Company 1Company Name / Location of Company*Dates of Employment*Direct Supervisor / Phone Number*Job Title / Describe FunctionsReason for Leaving (provide details)Starting Wage / Ending WageOkay to contact? Yes or No (If no, provide details or alternate contact.)*Company 2Company Name / Location of CompanyDates of EmploymentDirect Supervisor / Phone NumberJob Title / Describe FunctionsReason for Leaving (provide details)Starting Wage / Ending WageOkay to Contact? Yes or No (If no, provide details or alternate contact.)Company 3Company Name / Location of CompanyDates of EmploymentDirect Supervisor / Phone NumberJob Title / Describe FunctionsReason for Leaving (provide details)Starting Wage / Ending WageOkay to Contact? Yes or No (If no, provide details or alternate contact.)Employment Services Previous Work HistoryHave you ever worked for Staffing Service USA in the past?*1) Employment Service / Dates Employed & Assignment Information2) Employment Service / Dates Employed & Assignment Information3) Employment Service / Dates Employed & Assignment InformationWork PrioritiesWhat sort of challenges do you like on a job?What is most important to you most important when making a decision to take a position? (e.g., wages, benefits, location, security, etc.)Is advancement important? Yes or No. Explain.Do you have a Highschool Diploma or Equivalent?YesNoAdditional Education / DegreesAdditional Certifications or CredentialsAvailabilityAvailabilitySelect any that apply 1st Shift 2nd Shift 3rd Shift Mid Shift Any Shift Currently Working Full Time Part Time Short Term Summer Job Temporary Weekends Weekends Only Mornings Evenings Afternoons Light Industrial SkillsJob Fields Distribution Logistics Farming Manufacturing Medical Printing Security Guard Supervisor Transportation Para Technical Cleaning Painting Warehouse Clerical Skills Food Service Project Manager Construction Light Industrial Plumbing Estimator Please select any field that relates to you past work history and experience.Do you have? Hard Hat Steel Toed Shoes Do you know? Metric Scale Shop Math Tape Measure Type of work you will accept? Light Work (0-20 lbs.) Medium Work (21-50 lbs.) Heavy Work (over 50 lbs.) 50 lbs. Max Other Lab Technician Production Manager CAD Drafting Engineering Group Leader Draftsman Bricklayer Block Brick Hod Carrier Running Bond Clerical Basic Computer Skills Basic Computer Skills - Word Basic Computer Skills - Excel Collating Copying Data Entry Filing Reception Retail Customer Service Docutech Expediting Return Clerk Access Calculator Computer Operator Data Ease Data Entry - Alpha Data Entry - Num dBase MS Excel 7.0 MS Office MS Outlook MS Publisher MS Word MS Works PowerPoint Word 7.0 Word 8.0 Word Processing Construction Cabinet Installer Cabinet Maker Commercial Multifamily New Construction Carpentry Tools Power Tools Remodel Rough Trim Carpentry Drywalling Restoration Commerical/CRPN Own hand tools Drivers Auction Delivery Driver Box Truck Truck Driving Truck Driving - CDL A Truck Driving - CDL B Truck Driving - HAZMAT Truck Driving - Local Truck Driving - Over the Road Tractor Trailer Diesel Electrical Apprentice Commercial Journeyman Master Residential Electrical Experience Electro mechanic Food Service Bakery Bartender Banquet Banquet Server Banquet Attire Cashier Cook Food Prep Host/Hostess Line Server Waiter/Waitress Housekeeper Food Maintenance Dishwasher Food Processing Cannery Meat Packaging Poultry Produce General Labor Demonstrator Flagger Flagging Attire Floor Buffing Furniture Moving Inventory Janitorial Landscaping Lumber Handling Stock Clerk Floor Stripping Detailing Sanitation Snow Shoveling Light Industrial Assembly Bar Code Scanners Folding Gluing Hand Packaging Heat Sealing Inspecting Labeling Machine Packing Order Picking Riveting Shrink Wrapping Sorting Stapling Ticketing Weighing Production Rework Clothes inspecting Machines Maintenance Machine Maintenance Troubleshooting Repair Electrical Mechanical Control Circuits Motors Drives Conveyors Hydraulics Pneumatics Machine Assembly PLC Maintenance Manager Machine Operator CNC - Horizontal Lathe CNC - Vertical Lathe CNC - Milling Mchne CNC - Drilling Mchne CNC Operator Set-up - manual CNC Set-ups Brake Press Drop Press Floor Press Hayssen Mchne Milling Mchne Screwing Mchne Sewing Mchne Silk Screen Woodworking Woodworking - Router Woodworking - Saws Woodworking - Shaping Machine Operator Millwright Spinning Drill Press Measuring Micrometer Calipers Painting Exterior Interior Roller Spray Auto Para Tech Cable Harness Electronic Assembly Inspection Microscope PC Board Quality Assurance Quality Control Soldering Wire Wrap Plumbing Apprentice Commercial Journeyman Residential Printing Commercial Bindery Tabbing Three knife trimmer Cutter Folder Plate Making Pressroom Helper Web Press Sheet Feed Press Prepress Printing Apprentice Screen Printer Printing Press Skilled Air Tools Auto Recon Auto Mechanic Blow Mold Blueprint Reading Building Maintenance Electrical Circuitry Exhibit Setup Grinder Electronics Lathe Laundry Worker Machinist Molder (Extrusion) Molder (Injection) Pipe Fitter Plastic Shears Plastics Worker Punch Press Refrigeration Certified Sheet Metal Tolerance Tool & Die CAT Auto Inspection Deburrer Schematics Warehouse Operations Shipping Receiving Parts Room Attendant Cherry Picker Fedex Software Squeeze Lift Load/Unload Material Handler Pallet Jack Electric Pallet Jack Forklift - Sit-Down Forklift - Stand-Up High Lift Operator Forklift Certified Crane Bobcat Hand Jack Forklift Welding Aluminum Arc Gas Heliarc Maintenance Mig Stick Tig OtherSelect any that apply Camp Hill Carlisle Centerville Columbia Dauphin Elizabethtown Ephrata Gap Harrisburg City Hershey Highspire Lebanon Lemoyne Mechanicsburg Middletown Millersville Mt Joy New Holland Palmyra Work PreferencesAre you seeking Temporary, Part-Time or Full-Time work?Explain what type of position you are interested in finding based on your experience? (e.g., production, warehouse, forklift, clerical, etc.)When are you available to start work? Provide beginning and ending date.Do you have a specific hourly pay range expectation? (e.g., $10-12/hr)What distance are you willing to travel from home?Do you have reliable transportation to get to and from work?Please note if you would like a job location that is on the bus route.ResumeAttach your resumeAccepted file types: doc, docx, pdf.Resume must be in Word or PDF format This iframe contains the logic required to handle Ajax powered Gravity Forms.