Employment Application

Date
First Name* Middle Initial
Last Name*
Your Address* (Number Street City State Zip)

How long have you lived at this address

Your Email*

Phone number*

Date of Birth

If under 18 please list age

Are you legally eligible to work in the United States? YesNo
Do you hold a visa that allows you to work in the United States? YesNo
If you have a document That allows you to work in the United States, please it bellow
Expiration date:
Position applying for

and salary desired

Days available to work
No preferenceMondayTuesdayWednesdayThursdayFridaySaturdaySunday
How many hours can you work weekly?

What shifts can you work?
1st shift2nd shift3rd shift
Employment desired (please select all that applies)
Manufacturing (i.e., Machine Operator, QC Inspector, Forklift Operator)Skilled Manufacturing (i.e., Maintenance Mechanic, Production Supervisor, Engineer)Office/Clerical Work
Are you available to begin work immediately? YesNo
If no, when are you available to begin work?

Education Background

High School Name

High School Location (City & State)

Number of High School years completed

College Name

College Location (City & State)

Number of College years completed

College Major & Degree

Business or Trade School Name

Business or Trade School Location (City & State)

Number of Business or Trade School years completed

Business or Trade School Major & Degree

Professional School Name

Professional School Location (City & State)

Professional School years completed

Professional School Major & Degree

Have you ever been convicted of a crime? NoYes
If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation

What is your means of transportation to work?
CarPublic TransportationOther
Do you have a driver license? YesNo
Driver license number

State issued AKALARAZCACOCTDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY
Type of driver license
OperatorCommercial (CDL)Chauffeur
Expiration Date

People to be notified in case of emergency

Primary Contact

Name

Address

Telephone

Relationship

Secondary Contact

Name

Address

Telephone

Relationship

Military

Have you ever been in the armed forces? YesNo
Are you now a member of the National Guard? YesNo
Specialty

Date Entered
Discharge Date

Work Experience

Please list your work experience for the past five years beginning with the most recent job held. If you were self-employed, give firm name.

Name of the most recent employer (required)

Address (required)

Phone number (required)

Name of Supervisor (required)

Employment start date (required)
Employment end date (required)
Your last job title (required)

Reason for leaving (be specific) (required)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at the company (required)

Name of the second most recent employer

Address

Phone number

Name of Supervisor

Employment start date
Employment end date
Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at the company

Name of the third most recent employer

Address

Phone number

Name of Supervisor

Employment start date
Employment end date
Your last job title

Reason for leaving (be specific)

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at the company

Additional employers (if necessary)

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by Away Staffing Services, Inc., I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Away Staffing Services, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of Away Staffing Services, Inc.. Both the undersigned and Away Staffing Services, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that Away Staffing Services, Inc. may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give Away Staffing Services, Inc. permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release Away Staffing Services, Inc. from any liability as a result of such contract.

I also understand that (1) Away Staffing Services, Inc. has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing ofjob-related physical examinations.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Away Staffing Services, Inc. may obtain information about you for employment purposes from a third party consumer reporting agency and you understand that the information in your background check may be disclosed to any company you are assigned. These reports may contain information regarding your criminal history and social security verification. You have the right, upon proper request to request whether a consumer report has been run about you.

I further understand that my employment with Away Staffing Services, Inc. shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with Away Staffing Services, Inc. is terrninable at will for any reason by either party.

Away Staffing Services, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Away Staffing Services, Inc. depends solely on your qualifications.

Thank you for completing this application form and for your interest in Away Staffing Services, Inc.

DISCLOSURE OF BACKGROUND CHECK TO BE CONDUCTED ON YOU

In connection with your application and/or employment with Away Staffing Services Inc.(“Employer”) this notice is provided to inform you that a “consumer report” and/or “investigative consumer report”, as defined by the F air Credit Reporting Act, may be obtained from a consumer reporting agency for employment purposes. These types of reports may include information as to your character, general reputation, personal characteristics and mode of living, whichever are applicable. The report(s) may also contain information about you relating to your criminal history, credit history, driving and/or motor vehicle records, verification of your education or employment history and other background checks. They may involve interviews with sources such as your neighbors, friends or associates.

ACKNOWLEDGMENT AND AUTHORIZATION OF BACKGROUND CHECK

By signing below, I authorize Away Staffing Services Inc. (“Employer”) to obtain “consumer reports” and/or “investigative consumer reports” about me during the course of the application process and during the course of my employment, to the extent permitted by law. You have the right, upon written request made within a reasonable amount time after the receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report by contacting Crimcheck.com, Inc. 17295 Foltz Industrial Parkway, Suite B, Strongsville, OH 44149 [1-877-992-4325].

Minnesota applicants or employees only: You have the right, upon written request to Crimcheck.com, to receive a complete and accurate disclosure of the nature and scope of any consumer report. Crimcheck.com, Inc. must make this disclosure within five days of receipt of your request or of Employer’s request for the report, whichever is later. Please check this box if you would like to receive a copy of a consumer report if one is obtained by Employer.

Massachusetts and New Jersey applicants or employees only: You have the right to inspect and promptly receive a copy of any investigative consumer report requested by Employer by contacting the consumer reporting agency, Crimcheck.com, Inc., directly.

Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by Employer.

New York applicants or employees only: You have the right, upon request, to be informed of whether or not a consumer report was requested from a consumer reporting agency by contacting the consumer reporting agency, Crimcheck. If a consumer report is requested, you will again be provided with the name and address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by contacting Crimcheck. By signing, you acknowledge receipt of Article 23-A of the New York Correction Law.

Washington State applicants or employees only: You have the right to receive a complete and accurate disclosure of the nature and scope of any investigative consumer report as well as a written summary of your rights and remedies under Washington law.

California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

I consent to the conditions.