Online Application

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Personal Information

First Name*	M.I.* Last Name*
Address*
City*	State* Zip*
How long?*	years
Home Phone*
Cell Phone*
E-mail*
Previous Address
Previous City	Previous State Previous Zip
How long?	years

Check the following work options you would consider:
Temporary Temp-to-Hire Contract

Education

High School

Name
Location
Dates Attended
Graduate	Yes No
Graduation Date
Degree
Major

College or University

Name
Location
Dates Attended
Graduate	Yes No
Graduation Date
Degree
Major

Graduate School

Name
Location
Dates Attended
Graduate	Yes No
Graduation Date
Degree
Major

Technical School

Name
Location
Dates Attended
Graduate	Yes No
Graduation Date
Degree
Major

Other education, training, certifications, licenses or special skills related to this job:

Professional Licenses and/or Certifications

	Type	State	Expiration	Registration Number
1)
2)

References
List at least three employers of business related references

Reference #1

Name
Company
Title
Phone Number

Reference #2

Name
Company
Title
Phone Number

Reference #3

Name
Company
Title
Phone Number

Employment History
List all your former employers, beginning with the most recent.

Most Recent Employer
Starting Month/Year
Ending Month/Year
Name of Organization
Location of Business
Nature of Business
Title
Duties
Reason for Leaving
Supervisor's Name
Supervisor's Phone

Previous Employer
Starting Month/Year
Ending Month/Year
Name of Organization
Location of Business
Nature of Business
Title
Duties
Reason for Leaving
Supervisor's Name
Supervisor's Phone

Previous Employer
Starting Month/Year
Ending Month/Year
Name of Organization
Location of Business
Nature of Business
Title
Duties
Reason for Leaving
Supervisor's Name
Supervisor's Phone

Previous Employer
Starting Month/Year
Ending Month/Year
Name of Organization
Location of Business
Nature of Business
Title
Duties
Reason for Leaving
Supervisor's Name
Supervisor's Phone

Previous Employer
Starting Month/Year
Ending Month/Year
Name of Organization
Location of Business
Nature of Business
Title
Duties
Reason for Leaving
Supervisor's Name
Supervisor's Phone

Current Pay Rate
Desired Pay Rate

Do you plan to give two weeks notice at your current job?	Yes No
Are you registered with any other recruiting firms?	Yes No
If yes, which:

Criminal History

Have you ever been convicted of a felony, pleaded no contest to a felony, or been convicted of a misdemeanor? A conviction record will not necessarily bar you from employment.*
Yes No

If yes, explain:

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Job Seekers

"Encore Staffing has done a great job of figuring out what it is I want to do and the kind of company I want to work for. I've just been offered a job by the company I am currently temping at. I'm really excited about the opportunity! I would refer Encore Staffing to anyone serious about finding a good job."

-Bill K.