Personal InformationFirst Name*Middle Initial*Last Name*SS Number*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 Email* Phone Primary*Phone SecondaryPhone Secondary DescriptionCellphone*Cellphone Carrier*Select carrier to receive textsAlaska CommunicationsAliantAmeritechAT&TAT+T MobilityBell Mobility & Solo MobileBellSouthBoost MobileComcelCricketH2O WirelessMetroPCSOpt OutSprintSprint(PCS)Straight TalkT-MobileTracFoneUS CellularVerizonVirgin MobileDate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Other 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 every completed an OSHA class? If yes, when / where?Work HistoryStarting with the most recentCompany 1Company Name*Dates Employed / Location of Company*Direct Supervisor Name / Phone Number*Job Title / Describe Functions*Additional InformationReason For Leaving (provide details)*Starting Wage / Ending WageOkay to Contact? Yes or No ( If no, provide details or alternative contact.)*Company 2Company NameDates Employed / Location of CompanyDirect Supervisor Name / Phone NumberJob Title / Describe FunctionsAdditional InformationReason For Leaving (provide details)Starting Wage / Ending WageOkay to Contact? Yes or No ( If no, provide details or alternative contact.)Company 3Company NameDates Employed / Location of CompanyDirect Supervisor Name / Phone NumberJob Title / Describe FunctionsAdditional InformationReason For Leaving (provide details)Starting Wage / Ending WageOkay to Contact? Yes or No ( If no, provide details or alternative contact.)Employment Services Previous Work HistoryWere you ever registered with Staffing Service USA in the past? If yes, when and which location?*1) Employment Service / Dates Employed & Assignment Information2) Employment Service / Dates Employed & Assignment Information3) Employment Service / Dates Employed & Assignment InformationWork ExamplesTell us about a typical day on your last job.Typical day cont'dTypical day cont'dExplain a challenge you faced in a work situation- be specific. What was it and how did you handle it?Challenge Cont'dChallenge Cont'dWork PrioritiesWhat sort of challenges do you like on a job?What is most important when making a decision to take a position? (ie, wages, benefits, location, etc)Is advancement important? Yes or No ExplainDo you have a High School Diploma or GED?*YesNoAdditional Education / DegreeEducation / DegreeEducation / DegreeAdditional LicensesAvailability 1st Shift 2nd Shift 3rd Shift Any Shift Currently Working Full-time 1-2 Week Notice Part-time Am Part-time PM Part-time Evenings Part-time School Hours Short-term Summer Work Temp Only Weekends Weekends Only Job Fields & Industries Accounting Banking Benefits Administrator Buyer/Purchasing CAD Call Center Chemistry Church Communications Construction Dental Designer Desktop Publish Distribution/Logistics Drafter Education Employee Relations Engineering Finance Food Industry Fundraising Graphic Arts/Design Healthcare Hospital Hospitality Human Services Human Resources Insurance Information Technology Lab Technician Leasing Agent Legal MAC Operator Mailroom Management Manufacturing Manuscript Marketing Medical Mortgage Non-Profit Optical/Vision PC PC Repair PC Tech Pharmaceutical Printing Property Management Public Relations Real Estate Recruiting Restoration Retail Sales Sales Secretarial Security Social Work Software Support Software Tech Supervisor Technical Writer Telemarketing Trade Shows Training Transportation Travel Web Design Accounting Auditor Accountant - Staff Accountant Accountant - Cost Accountant - Tax Accountant - Partnership Accountant - CPA Controller Credit Analyst Financial Analyst Accounts Receivable Accounts Payable Payroll Credit / Collections Bookkeeping Assistant Bookkeeping Full Charge Bookkeeping Double Entry Bookkeeping Trial Balance Bookkeeping General Ledger Bank Reconciliation Tax Forms Tax Preparation Billing Medical / Non-clinical Medical / Dental Medical Assistant Medical Claims Processor Medical Collections Medical Reception Medical Records Medical Secretary Medical Terminology Medical Transcription Patient Registration Medical Records Coding Medical Billing ICD-9 Coding Medical Billing CPT-5 Coding Medical Billing UB-92 Coding EOB Statements MediSoft HIPPA Regulations JCAHO Clinical Supervisor Practice Administrator Medical Office Manager Scheduling Supervisor Dental Assistant Dental Claims Processor Dental Reception Dental Scheduler Marketing / Customer Service Customer Service Retail Sales Product Demonstrator Telemarketing - Outbound Telemarketing - Inbound Trade Shows / Seminars Sales - Inside Sales - Outside Banking / Mortgage Teller Branch Manager Mortgage Front End Processor Mortgage Processor Mortgage Closer Mortgage Post Closer Mortgage Underwriter Mortgage Originator Mortgage FHA Loans Mortgage VA Loans Calyx Point Technology Applications Developer Business Analyst DBA - Database Analyst Help Desk Network Administrator Network Engineer PC Technicians Programmer Programmer Analyst Software Developer Systems Analyst System Administrator Technical Support Technical Writer Web Designer/Developer Office & Professional Skills (listed alphabetically) Adding Machine Admin Assistant Administrative Bilingual - Skills Calculator Cashier Clerical Collating Collections Copy Data Entry - 10 Key Data Entry - Alpha Numeric Dispatch Drafting Executive Asst Filing - Alpha Numeric Filing - Numeric Forms General Ledger Graphs Inventory Control Legal Terminology Light Clerical Loan Processor Messenger Microfilm Notary Office Management Paralegal Payroll Photocopy Post/Code/Figure Postage Meter Print Shop Production Planner Production Scheduler Proofing Machine Proofreader Proposals Quality Assurance Reception (1-6 lines) Reception (7+ lines) Receptionist Recruitment Scheduling Secretarial Shipping/Receiving Shorthand Sign Language Sort/Distribute Mail Statistical Data Switchboard Transcription Typewriter Typing Word Processing Software Skills ACT Adobe Illustrator Adobe Workshop AS400 AutoCAD CADKey Dreamweaver EDI Freelance Graphics Front Page Gerber Great Plains HTML Internet Explorer JD Edwards Linux Lotus 123 Lotus Approach Lotus Notes MAS 200 MAS 400 MAS 500 MAS 90 MS Access MS Excel MS Outlook MS Outlook Express MS Powerpoint MS Project MS Publisher MS Word MS Works Netscape Oracle PageMaker Peachtree PeopleSoft Photo Shop PHP Programming QuickBooks Quicken SBT SAP SQL StarBuilder Timberline Unix Visual FoxPro Windows 98 Windows NT Windows XP Windows Vista Word Perfect Windows 7 Please check the boxes where you have software skills, experience or training.Geographical Area To Work Anywhere Up To 1 Hr Drive Up To 15-30 Min Up To 30 Min Drive Adamstown Akron Berks County Blue Ball Centerville Columbia Dauphin County Denver Downtown Lancaster East Hempfield East Petersburg Eastern Lancaster County Elizabethtown Ephrata Gap Greenfield Area Hanover Harrisburg Harrisburg City Hershey Highspire Intercourse Lampeter/Strasburg Lancaster Lancaster County Landisville Lebanon Lemoyne Leola Lititz Manheim Marietta Mechanicsburg Middletown Millersville Mount Joy Mountville New Holland No Downtown Lancaster Northern Lancaster County Paradise Quarryville Salunga Southern Lancaster County Steelton Strasburg W. Lanc. County Willow Street Wrightsville Work Environment InformationWhat size company do you prefer to work?Any preference on company atmosphere? Explain.What type of environment do you prefer? (i.e. fast paced)Do you like a lot of interaction with others in a position? Explain.Work PreferencesAre you seeking Temporary, Part-time, Full-time or an Internal Staffing Service USA position?Explain what type of position you are interested in finding based on your experience? (i.e. - clerical, accounting, IT, call center, etc)When are you available to start work / and until what date?Do you have a specific salary expectation?Attach resume belowAccepted file types: doc, docx, pdf, jpg, gif, png.Resume must be in Word or PDF format. Please name the file your first and last name and date. (IE. JohnDoe11-09) This iframe contains the logic required to handle Ajax powered Gravity Forms.