EMPLOYMENT APPLICATION

Thank you for taking the time to complete our online employment application.
Please fill out the application below as completely as possible.
This application will take approximately
15 minutes to complete.

Personal Information

Are you at least 18 years of age and do you have the legal right to work in the United States?
Yes No
First Name (Required)
Middle Name
Last Name (Required)
Nickname / Preferred Name
Street Address
Apartment
City
StateZip Code
Home Phone(Required)
Area code and phone number

Other Phone – Area code and phone number

Email Address
Resume – If you have a plain-text resume, paste it into the box below.

Availability

Are you willing to work temporary?
YesNo
Are you looking for a full-time career position?

Yes No

Are you looking for contract positions?

Yes No

When are you available to start?

Month
Day
Year
What weekday hours are you available?
What weekend hours are you available?

How many hours are you willing to work in a week?
Are you willing to work overtime?

YesNo

What is the minimum pay you desire? Hourly rate or annual salary
How much notice will you need if a position is offered to you?
How many miles are you willing to travel to a position?
Which office are you applying to?

Education

Enter most recent – Do not enter start and end date if the most recent is high school
Name of School
Type of school
Street Address
City
State
Zip Code
Start Date
MonthYear
End Date
MonthYear
Degree
Major Study Area
Other Studies

Recent Employment

List most recent first
Company Name
Street Address
City
StateZip
Supervisor Name
Job Title
Job Duties
Start Date
MonthYear
End Date
MonthYear
Start Wage
Hourly rate or annual salary
End Wage
Hourly rate or annual salary
May we contact this employer for a reference check?
YesNo


Company Name
Street Address
City
State
Zip
Supervisor Name
Job Title
Job Duties
Start Date
MonthYear
End Date MonthYear
Start Wage Hourly rate or annual salary
End WageHourly rate or annual salary
May we contact this employer for a reference check?YesNo


Company Name
Street Address
City
StateZip
Supervisor Name
Job Title
Job Duties
Start Date
MonthYear
End Date
MonthYear
Start Wage
Hourly rate or annual salary
End Wage Hourly rate or annual salary
May we contact this employer for a reference check?YesNo


Criminal Background & Drug Screen

Have you been convicted of a crime in the last 7 years, other than a minor traffic violation? If yes, please explain: YesNo
Are you willing to take a drug screening test?YesNo

Administrative

Customer ServiceReception/PhonesAdministrative AssistantHuman ResourcesInsuranceMedicalBi-lingual Spanish

Accounting

APARPayrollClerkBook KeeperCost AccountingPayrollAccountantCollectionsQuickbooks
I certify that the statements I have made to StaffSource, Inc. are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize StaffSource, Inc. to obtain information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.

When I am employed by StaffSource, Inc. I agree that if at any time I make claims against Bolt Staffing Service, Inc. for personal injuries, I will submit myself, upon written request, to examination by a physician or physicians of StaffSource’s selection, at StaffSource’s expense, as often as may be requested.

I also agree that if I am employed by StaffSource, Inc., now or at any time in the future, my employment may be terminated by Bolt Staffing Service, Inc. at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination.

I agree that I have been informed of the requirements of the work for which I am applying, and that the information on this application is correct and complete to the best of my knowledge. I understand that it shall be grounds for my immediate dismissal if any of the information contained herein is found to be untrue. I authorize you and all former employers given by me as references, to answer all questions and to give all information in connection with this application or in any way concerning me.

I understand that if accepted for employment, I will be working for you on your payroll, at your client’s premises. I agree that I will obtain your permission before discussing direct employment with your client. I agree to immediately notify you at the conclusion of each assignment or as soon as I become available. If I fail to give such notice, you may assume that I am not available for re-assignment, and am not ready willing and able to work. I understand that any information I learn while working for a client is to be kept confidential. I will hold you harmless from any claims including, but not limited to, personal injury or illness as a result of my providing false or misleading information on this application. I hereby acknowledge that my employment is “at will”, that I may resign at any time and the company may terminate my employment at any time, with or without cause. Accordingly, I agree that, while the employment relationship continues, I will be paid in accordance with the regular payday rules governing current employees. I will be paid on regular paydays following the completion of services on any temporary assignment. If I expressly notify you of my decision to quit, or if I am terminated, I will receive my final wages sooner, as the law requires.

Please take a moment to review your application. Indicate that you have read the above statement by entering your initials in the box below. To complete this application, click on the Submit Application button.

Initials:
This Company 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 this Company depends solely on your qualifications.

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