Begin Application

Acceptable Characters ( ) - + and space

FLEXIBLE STAFFING OF GEORGIA
Employment Application
Flexible Staffing of GA is an equal opportunity employer. We do not discriminate on the basis of race, color, veteran status, national origin, disability, age, sex, marital status, or any other legally protected status.
APPLICANT INFORMATION(INFORMACION DEL APPLICANTE)
Last Name*
Apellido
First*
Nombre
M.I.
Date*
Fecha
Street Address*
Direccion
Apartment/Unit #
No. de Apartamento
City*
Ciudad
State*
Estado
ZIP*
Codigo Postal
Phone*
Telefono
Acceptable Characters ( ) - + and space
E-mail Address*
CorreoElectronico
Date of Birth*
Fechade Nacimiento
Social Security No.*
Numero de Seguro
Desired Salary
SalarioRequerido
Position Applied for
La Posicionapplicada
Are you a citizen of the United States? *
Esciudadano de losEstadosUnidos?
YES
Si
NO
No
If no, are you authorized to work in the U.S.? *
Si no, estaautorizado a trabajarenlosEstadosUnidos?
YES
Si
NO
No
Have you ever worked for this company? *
A trabajado antes para estacompañia?
YES
Si
NO
No
If so, when? *
Si si, Cuando?
How far are you willing to travel?
Que distanciaestadispuesto a recorrer?
Shift Preference?
Turnopreferido?
How did you hear of us?
Como escucho de nosotros?
EDUCATION(EDUCACION)
High School * Address *
Direccion
From*
Desde
To*
Hasta
Did you graduate? *
Se graduo?
YES
Si
NO
No
Degree *
College Address
Direccion
From
Desde
To
Hasta
Did you graduate?
Se graduo?
YES
Si
NO
No
Degree
Other Address
Direccion
From
Desde
To
Hasta
Did you graduate?
Se graduo?
YES
Si
NO
No
Degree
Other Address
Direccion
From
Desde
To
Hasta
Did you graduate?
Se graduo?
YES
Si
NO
No
Degree
Other Address
Direccion
From
Desde
To
Hasta
Did you graduate?
Se graduo?
YES
Si
NO
No
Degree
PREVIOUS EMPLOYMENT(PREVIO EMPLEO)
Company*
Compañia
Phone*
Telefono
Acceptable Characters ( ) - + and space
Address*
Direccion
Supervisor *
Job Title*
Titulo
Starting Salary $*
Salario al comensar
Ending Salary $*
Salario al final
Responsibilities
Responsabilidades*
From*
Desde
To*
Hasta
Reason for Leaving*
Razonporirse
May we contact your previous supervisor for a reference?*
Podemos contactar al supervisor comoreferencia
YES
Si
NO
No
If no, please provide explanation
Company
Compañia
Phone
Telefono
Acceptable Characters ( ) - + and space
Address
Direccion
Supervisor
Job Title
Titulo
Starting Salary $
Salario al comensar
Ending Salary $
Salario al final
Responsibilities
Responsabilidades
From
Desde
To
Hasta
Reason for Leaving
Razonporirse
May we contact your previous supervisor for a reference?
Podemos contactar al supervisor comoreferencia
YES
Si
NO
No
If no, please provide explanation
Company
Compañia
Phone
Telefono
Acceptable Characters ( ) - + and space
Address
Direccion
Supervisor
Job Title
Titulo
Starting Salary $
Salario al comensar
Ending Salary $
Salario al final
Responsibilities
Responsabilidades
From
Desde
To
Hasta
Reason for Leaving
Razonporirse
May we contact your previous supervisor for a reference?
Podemos contactar al supervisor comoreferencia
YES
Si
NO
No
If no, please provide explanation
Company
Compañia
Phone
Telefono
Acceptable Characters ( ) - + and space
Address
Direccion
Supervisor
Job Title
Titulo
Starting Salary $
Salario al comensar
Ending Salary $
Salario al final
Responsibilities
Responsabilidades
From
Desde
To
Hasta
Reason for Leaving
Razonporirse
May we contact your previous supervisor for a reference?
Podemos contactar al supervisor comoreferencia
YES
Si
NO
No
If no, please provide explanation
Company
Compañia
Phone
Telefono
Acceptable Characters ( ) - + and space
Address
Direccion
Supervisor
Job Title
Titulo
Starting Salary $
Salario al comensar
Ending Salary $
Salario al final
Responsibilities
Responsabilidades
From
Desde
To
Hasta
Reason for Leaving
Razonporirse
May we contact your previous supervisor for a reference?
Podemos contactar al supervisor comoreferencia
YES
Si
NO
No
If no, please provide explanation
*MILITARY EXPERIENCE (ExperienciaMilitar) YES
Si
NO
No
Branch
Rama
Phone
Telefono
Acceptable Characters ( ) - + and space
Rank at Discharge
Supervisor
Dates of Service
Starting Salary $
Ending Salary $
REFERENCES
Name *
Nombre
Phone *
Telefono
Acceptable Characters ( ) - + and space
Relation *
Relacion
Name
Nombre
Phone
Telefono
Acceptable Characters ( ) - + and space
Relation
Relacion
Name
Nombre
Phone
Telefono
Acceptable Characters ( ) - + and space
Relation
Relacion
DISCLAIMER AND SIGNATURE(Firma y Desmentimiento)
I certify that my answers are true and complete to the best of my knowledge.*
Yocertifico que todas las repuestasdadas son ciertas.
*YES
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Si estaapplicacionresultaenempleo, yoentiendo que algunainformaciondadaen la applicacion que sea falsa puederesultarenterminacion de empleo.
Signature *
Firma
Date *
Fecha
Flexible Staffing of Georgia is an equal opportunity employer. We do not discriminate on the basis of race, color, veteran status, national origin, disability, religion, age, sex, marital status, non-job related disability, or any other legally class protected by local or state ordinance.
Flexible Staffing of Georgia es un empleador de igualdad de oportunidades. No discriminamosen base a raza, color, condición de veterano, origennacional, discapacidad, religión, edad, sexo, estado civil, u otraclaseprotegigdaporordenanza local o estatal.

logo
CONSENT AND AUTHORIZATION
I do here by give to Flexible Staffing of Georgia or any of it's agents, authorization to disclose orally or in writing the results of this background check to the employer or designated authorized recipient. I have read this authorization and give full consent without reservation for a background check to be conducted on me. Flexible Staffing of Georgia may make an investigative report in which information may be obtained regarding my criminal records, education and employment history, motor vehicle records, use of the internet including social networking sites, and any other applicable personal information. I certify that all information provided is truthful, accurate and provided voluntarily.
I release and will hold all parties concerned harmless, meaning that I will not sue nor hold responsible for any alleged harm to me or interfering with my obtaining a job or continuing employment due to a result of a report. I further authorize you to secure an investigation at any time, and any number of times, before, during and after my employment, if in the company's discretion, it has a legally permissible and legitimate business need for the information requested.
Please print all information CLEARLY.
*Information required for identifier purposes only*
FirstName*
Middle Name
Last Name*
Signature*
Today's Date*
Social Security Number*
Date of Birth*
Sex*
Race*
Current Address*
City*
State*
ZipCode*
Driver's License Number & State*
**FOR RECRUITER USE ONLY**
The purpose of this background check will be for: Employment Volunteer(Only check one box)
**Special employment provisions(Check if applicable)**
Employment with: Mentally Disabled ElderCare Children
One of the following MUST be checked: How long, from today's date, will this authorization be valid?
One-Time Only 90Days Periodic checks may be made by this company for the duration of my employment.