Application Date of Application MM slash DD slash YYYY It is the policy of this company not to discriminate against any applicant for employment, or any employee because of his/her race, creed, sex, age, religion, disability, national origin, or veteran’s status. This policy of providing equal employment opportunity without regard to an individual’s race, creed, sex, age, religion, disability, national origin, or veteran’s status supersedes and takes precedence over any provisions of this application or any other policy which may be interpreted to be in conflict with. No question or statement on this application is intended to secure information, which by its nature or use is discriminatory. Consideration for employment is dependent upon you meeting all minimum qualifications required for the position for which you are applying. Print Name Other Names Used Present Address Street Address City State Zip Code Cell PhoneAlternate PhoneE Mail When Are You Available to Work?FROM MondayTuesdayWednesdayThursdayFridaySaturdaySundayTOTOMondayTuesdayWednesdayThursdayFridaySaturdaySundayWeight You Can Lift Up to 25 lb. 25-50 lb. 51-100 lb. Over 100 lb. Check All That Apply Days Nights FT PT Summer Only Rotating Shift Temporary Overtime Foreign Language Skills Language Speak Read Write Language Speak Read Write Education & TrainingName of SchoolHigh SchoolCityStateGraduated? (Yes/No)Major Field of StudyBusiness or TradeCityStateGraduated? (Yes/No)Major Field of StudyCollege/UniversityCityStateGraduated? (Yes/No)Major Field of StudyMilitaryCityStateGraduated? (Yes/No)Major Field of StudyAre you a member of the Armed Services? What branch of the military did you enlist? What was your military rank when discharged? How many years did you serve in the military? What skills do you possess that would be an asset for any positions we may have? List here Work Experience Name of Employer PhoneAddressJob Title & DutiesDate Started MM slash DD slash YYYY Date Left Reason May we contact present employer Yes No Name of Previous Employer PhoneAddressJob Title & DutiesDate Started MM slash DD slash YYYY Date Left Reason Check All That Apply Bookkeeping Accounting Windows (computer) Microsoft365 Excel (computer) Accounts Rec./Pay Quickbooks Computer/Programming Multiline Phone System Data Entry 10 Key (by touch) File Clerk Receptionist Transcriptionist Word processing Payroll Clerk Taxes Insurance Banking Cashier Fast Food Restaurant Waitress/Waiter Cook Housekeeping Nurse Aid LVN Industrial Mechanic Air Cond/Heat Body shop Diesel Mechanic Injection Molding Welding Inventory Clerk Sand Blast Machine Operator Drill Press Shear Brake Lathe Operator Table Saw Production Assembly Furniture Moving Warehouse Work Forklift Operator Landscaping Concrete Work Carpentry/Painting Plumbing Electrical Journeyman Drywall Hang/Finish Maintenance Janitorial Security Plastic Molding Soldering Truck Driver CDL Type Farm/Ranch Shipping/Receiving Dozier Backhoe Front End Loader Dump Truck Draftsman Blueprints Fabricator Management Retail Industrial Sheet Metal Roofing Other Current Certifications Date MM slash DD slash YYYY I UNDERSTAND AND AGREE THAT: 1. Any material misstatement or deliberate omission of a relevant fact by me in this application, a resume, and/or attachment will be sufficient cause for termination consideration of my application or my subsequent employment. 2. Need’em Help Temporaries, Inc. may procure or have prepared an investigative/credit report to verify any information affecting my employment. 3. My employment with Need’em Help Temporaries, Inc. may be subject to satisfactory completion of a physical examination, which will include a drug screening test, conducted at the direction of Need’em Help Temporaries, Inc. prior to my employment or at such time as may be required by Need’em Help Temporaries, Inc. Further, my employment may be subject to satisfactory completion of a standardized employment aptitude or qualifications test administered to me to determine my fitness for a position. The purpose of the test is to measure my safety aptitude and my suitability for employment according to certain standardized risk factor determinations, and I hereby give my consent for such test to be administered to me if required as a condition of my employment. 4. IF I AM EMPLOYED BY NEED’EM HELP TEMPORARIES, INC. MY EMPLOYMENT AND COMPENSTION MAY BE TERMINATED AT ANY TIME AT THE OPTION OF EITHER NEED’EM HELP TEMPORARIES. INC. OR MYSELF, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE. UPON COMPLETION OF MY WORK ASSIGNMENT, I AM TO CONTACT NEED’EM HELP TEMPORARIES, INC. AND LET THEM KNOW I AM AVAILABLE FOR REASSIGNMENT, IF ANOTHER ASSIGNMENT IS NOT AVAILABLE IMMEDIATELY, I AM TO CHECK IN DAILY, MONDAY THROUGH FRIDAY, IN PERSON OR BY PHONE, 806-293-5609. A CORRECT, WORKING TELEPHONE NUMBER WITH A RELIABLE SOURCE OF CONTACT MUST BE PROVIDED AT ALL TIMES. FAILURE TO REPORT AND PROVIDE A CORRECT, WORKING TELEPHONE NUMBER AND RELIABLE SOURCE OF CONTACT MAY JEOPARDIZE ANY POTENTIAL UNEMPLOYMENT BENEFITS 5. I understand that it is the practice of the company to conduct drug and alcohol test for the purpose of carrying out policy. I understand that I cannot be compelled to give a specimen of my saliva, urine or breath. I understand that if I give a specimen that it will be tested for drugs and/or alcohol. I understand that the giving of a specimen when requested by the company is a condition of continued employment. 6. I authorize the institutions and individuals listed on this application to give Need’em Help Temporaries, Inc. any information they may have, personal or otherwise, concerning my previous employment, educational background, or personal character, and I release all parties from any liability that may result from furnishing such information to Need’em Help Temporaries, Inc. 7. If my application for employment or my employment is subject to a local ordinance, state statute or law that supersedes any provision of this application form, then that ordinance, statute or law will apply. 8. SHOULD YOU SUSTAIN AN INJURY WHILE WORKING ON A JOB WHERE WE PLACED YOU, THERE ARE SEVERAL STEPS YOU MUST TAKE: INFORM YOUR SUPERVISOR AND NEED’EM HELP TEMPORARIES, INC. IMMEDIATELY. THERE IS INFORMATION HE/SHE NEEDS TO KNOW FOR IMMEDIATE ACTION AND FOR NECESSARY REPORTING. IF THE INJURY IS MINOR, IT MAY BE TREATED BY FIRST AID ON LOCATION AND REQUIRE NO FURTHER ACTION. IF THE INJURY IS MORE SERIOUS, BUT NOT LIFE THREATENING, NOTIFY NEED’EM HELP TEMPORARIES, INC. IMMEDIATELY. IF THE INJURY IS LIFE THREATENING, TAKE WHATEVER ACTION IS NECESSARY TO OBTAIN TREATMENT AT THE NEAREST MEDICAL FACILITY. I certify that the information contained in this application is true, correct, and complete. I understand that, if employed, false statements reported on this application may be considered sufficient cause for termination. Have you ever been convicted of a felony? Yes No Have you ever been convicted of a misdemeanor? Yes No Signature Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged.
