Temp to Hire Online Application

Temp to Hire Online Application

Application Date:

First Name:
Last Name:
Social Security Number:

Address 1:
Address 2:
Home Phone:
Work Phone:
Work Ext:

City:
State:
Zip:
Cell Phone:
Email Address:

Salary Desired:
Date Available for Employment:
Position Desired:

Education

Last High School:
Date Attended From:
To:

City:
State:
Academic Degree:
Academic Major:
GPA:
Grad. Year:

Jr. College, college or University:
Date Attended From:
To:

City:
State:
Academic Degree:
Academic Major:
GPA:
Grad. Year:

Technical or Vocational School :
Date Attended From:
To:

City:
State:
Academic Degree:
Academic Major:
GPA:
Grad. Year:

Other Details of Experience or Training. Include Information on Adult Education Programs:

School :
Date Attended From:
To:

City:
State:
Degree/Certificate:
Yr Completed:

Prior Employment

List your last four(4) employers, assignments, etc. starting with the most RECENT.

Current or Last Employer:
Telephone:
Date Employed From:
To:

Address:
City:
State:
Zip Code:
Immediate Supervisor's Name:

Job Title:
Position:
Salary:
Hourly Rate:

Job Duties/Description of your work assignment:

Reason for Leaving:

Previous Employer:
Telephone:
Date Employed From:
To:

Address:
City:
State:
Zip Code:
Immediate Supervisor's Name:

Job Title:
Position:
Salary:
Hourly Rate:

Job Duties/Description of your work assignment:

Reason for Leaving:

Previous Employer:
Telephone:
Date Employed From:
To:

Address:
City:
State:
Zip Code:
Immediate Supervisor's Name:

Job Title:
Position:
Salary:
Hourly Rate:

Job Duties/Description of your work assignment:

Reason for Leaving:

Previous Employer:
Telephone:
Date Employed From:
To:

Address:
City:
State:
Zip Code:
Immediate Supervisor's Name:

Job Title:
Position:
Salary:
Hourly Rate:

Job Duties/Description of your work assignment:

Reason for Leaving:

Additional Information

Will you accept part-time work?:
Yes No Full-Time Work?:
Yes No Temporary Work?:
Yes No

Will you accept assignments that may lead into permanent work, but starts out as a "temp-to-hire"?:
Yes No

Days Desired (Check all that apply):
Mon Tues Wed Thurs Fri Sat Sun

Maximum distance you will travel:

Do you have a driver's license?:
Yes No

Explain:

Desired Hours:
1st Shift 2nd Shift 3rd Shift Do you have a resume?:
Yes No (Please Provide)

Do you have your own transportation?:
Yes No If no, do you have reliable transportation?:
Yes No

Explain:

How did you hear about us?:

Personal Information

Are you of legal age to work in the U.S.?:
Yes No May we run a Criminal Background Check?:
Yes No

Have you ever been convicted of a criminal offense? (Conviction of a crime will not automatically disqualify you from employment.) You are not obligated to disclose sealed or expunged records of arrests or convictions.:
Yes No Explain:

Have you ever working with a staffing Agency?:
Yes No If yes, what agency?:

What fluent languages are you fluent in?:
Spanish French German Other:

What is your career goal/future plans?:

What strengths do you bring to an employer?:

What weaknesses do you bring to an employer?:

How do you rate your overall attendance from past employment?:

Tell us what past employers will say about you as an employee (performance, attitude, etc)?:

Why are you looking for a new job(or reason for thinking about leaving current employer)?:

What did you like least?:

When are you available to interview?:

Are you interviewing with any other company?:

How long do you plan to stay in Southwest Iowa?:

By submitting this application, I certify that the information above is true and that any misrepresentation or falsification of these facts will be considered cause for immediate dismissal from any employment assigned by Grapevine Staffing. I hereby authorize my former employers to furnish any or all information regarding my employment record and any or all other information, personal or otherwise, which may or may not be recorded. I understand that I may be asked to perform a pre-employment drug screen. I also authorize Grapevine Staffing to run a background check in all States of the United States which includes but not limited to; Verification of records for: Criminal, Sex Offender, Social Security Trace, Credit, Motor Vehicle, Employment, Education, Personal Reference, and Professional Licensing. I hereby release all such employers and Grapevine Staffing, including their representatives and agents, from all liabilities for any damage whatsoever for furnishing said information.