* Required Information

Personnel Information

*First Name *Middle Name
*Last Name
*Address
*City *State *Zip Code
*Area Code & Phone Number
Emergency Phone Number
Social Security Number:
Driver's License Number: State:
EMail Address

Shifts Available Select Shifts Days Evenings Weekends Prefer Select Items Temp Temp-to-Hire Long Term Short Term
(Hold down Control key to select multiple items)

Have you ever worked for a temp service before?
Yes No If yes, which service?

Are you bondable? Yes No

Skills
(please check all that are applicable)

COMPUTERS:

Lotus123 Excel Quicken WordPerfect
MS Word Macintosh Paradox Windows
PowerPoint Access MSProject
Outlook Symphony

DATA PROCESSING:

10 Key Alpha Numeric
Keystrokes per Hour (K.S.P.H.)

BOOKKEEPING:

Accounting Degree Full-Charge
Payroll EDP Manual Receivables Payables
Taxes Specify
Bank Reconciliation Job Costing Budget Analysis
Collections Purchasing

FOREIGN LANGUAGE:

Language Select One Spanish Vietnamese French German Italian Chinese Speak Read Translate
Language Select One Spanish Vietnamese French German Italian Chinese Speak Read Translate

CUSTOMER SERVICE:

Surveys Phone Sales Demonstrator
Sales Assistant Customer Service Call Center
Credit/Collections Retail Sales Help Desk
Other Please Explain

GENERAL OFFICE:

Merlin AT&T Receptionist
No. Of Lines No. Of Extensions Mail Clerk

TYPES OF COMPANIES YOU HAVE WORKED FOR:

Legal Engineering Insurance Personnel
Sales Oil/Gas Finance Refinery
AutoCad Real Estate Manufacturing
Programmer Leasing Agent Electronic
Lab Tech

INDUSTRIAL:

Certified Fork Lift Fork Lift Materials
Catering Driver CDL DRiver Construction
Warehouse Inventory Meter Reader
Maintenance Firewatch Line Assembly

SAFETY TRAINING:

(Please list any Safety Training courses you may have had)

1.
2.
3.
4.
5.
6.

Industrial Only:

Do you have dependable transportation: Yes No
Have you had any moving violations in the last 3 years: Yes No
If YES, please explain violation, including dates:

Would you submit to drug tests? Yes No
Do you have a fear of heights? Yes No
Do you wear glasses/contacts? Yes No
Do you have: Choose Items Steel Toe Boots Hardhat Safety Glasses
(Hold down Control key to select multiple items)

List safety certificates held:

Employment History

1. PRESENT OR LAST EMPLOYER

From: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year (format year i.e. 2003)
To: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year
Firm Name: Phone No.
Firm Address:
Type of Business:
Reason for Leaving:
Position: Start End
Salary: Start $ End $

2. PREVIOUS EMPLOYER

From: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year (format year i.e. 2003)
To: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year
Firm Name: Phone No.
Firm Address:
Type of Business:
Reason for Leaving:
Position: Start End
Salary: Start $ End $

3. PREVIOUS EMPLOYER

From: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year (format year i.e. 2003)
To: Mo. 01 02 03 04 05 06 07 08 09 10 11 12 Year
Firm Name: Phone No.
Firm Address:
Type of Business:
Reason for Leaving:
Position: Start End
Salary: Start $ End $

Education

HIGH SCHOOL

Name of School
City & State
Years Attended: From To (i.e. 2003)
Last Yr Completed Select One 10 11 12
Did You Graduate: Yes No
Average Grade: Select One A B C D F Major Subjects:

G.E.D.

Name of School
City & State
Years Attended: From To (i.e. 2003)
Did You Graduate: Yes No
Average Grade: Select One A B C D F Major Subjects:

BUSINESS-TECHNICAL

Name of School
City & State
Years Attended: From To (i.e. 2003)
Last Yr Completed Select One 1 2 3 4
Did You Graduate: Yes No
Average Grade: Select One A B C D F Major Subjects:

COLLEGE

Name of College
City & State
Years Attended: From To (i.e. 2003)
Last Yr Completed Select One 1 2 3 4
Did You Graduate: Yes No
Average Grade: Select One A B C D F Major Subjects:

POST-GRADUATE

Name of College
City & State
Years Attended: From To (i.e. 2003)
Last Yr Completed Select One 1 2 3 4
Did You Graduate: Yes No
Average Grade: Select One A B C D F Major Subjects:

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