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Important Application Notes:

Tips for successfully completing the application on the first try:
1. Gather the required application information before you begin. You will be asked to provide the following:
- Your complete job history information including dates of employment, the company names and complete mailing addresses of former employers.
- The name, company and contact information for your references.
- Your driver license # (if applicable).

2. Please ENABLE JAVASCRIPT and TURN OFF POP-UP BLOCKERS on your computer.
This will ensure that you see notifications and on-screen instructions for correcting any errors so that you can successfully submit your application

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Resume Text  
 Contact Information
Please provide your legal name as it appears on documents used for identification. Abbreviations and nicknames are not acceptable.
First Name *   Last Name *  
Middle Name *     
Verify First Name *   Verify Last Name *  
Please check the box to verify this is your legal name as it appears on your identification. *
Address *   Address 2  
Address 3   City *  
State/Province *   Zip/Postal *  
Email *  
Preferred Name *  
Phone *   XXX-XXX-XXXX
  Preferred Phone
Alternate Phone   XXX-XXX-XXXX
Enter last 4 digits of SSN
  Verify last 4 digits of SSN *  
Passwords must be a minimum of 6 characters and have at least 2 numbers and 2 letters. Passwords ARE case-sensitive.
Password *   Confirm Password *  
Date Available   MM/DD/YYYY Desired Salary Range *  
Have you ever applied to any of our offices before? *   Yes   No
Have any of your friends and family worked for the Employer, now or in the past? *   Yes   No
If YES, please explain the circumstances.
Are you 18 or older? *   Yes   No
When you interview with our service, will you be able to provide the following valid documentation?
Identity (Picture ID) *   Yes   No
Eligibility to Work in the US *   Yes   No
Information provided is subject to verification with the Social Security Administration and/or the US Citizenship and Immigration Services.
Have you been a temporary with another service before? *
Yes   No   If YES, we will ask you to complete a Temporary Experience Supplement during your interview.
Some positions may require the ability to speak more than one language. If you would like to be considered for such positions, list all languages spoken other than English.
Hold the Ctrl key (on a PC) or the Command key (on a Mac) and click to select multiple languages.
Where Did You Hear About Us *  
 Assignment Information
Asmt No.
Type of work desired *  
Desired Shift *
Availability *   Full-time  Part-time  Either
Minimum Pay Rate $ *   per hour Miles willing to travel? *  
Have you been discharged or asked to resign from any job? *  Yes   No
If YES, please explain the circumstances.
Have you ever been reprimanded, suspended with or without pay, or terminated for fighting on the job, whether or not it was your fault? *
Yes   No  If YES, please explain.
Will any of your work references disclose/reveal anything negative? * Yes   No
If YES, please explain.
If a driver license is required for the position for which you are applying, do you have a valid license? *  Yes   No
License No.   Exp. Date 
State of Issue 
Since you are applying for a position which may require driving, have you been cited for a traffic violation of any kind within the past 7 years? *
Yes   No
If YES, please give date and details.
Have you ever plead guilty, "no contest", or been convicted of a felony or misdemeanor crime since the age of 18, including such moving violations as driving under the influence of a drug or alcohol, which were not later expunged?
(Baltimore, MD / District of Columbia / Hawaii only - do not respond to this inquiry until you have been given a conditional offer of employment. Buffalo, NY only - do not answer this question. California only - do not disclose convictions for a marijuana offense if the conviction occurred more than two (2) years prior to the date this application is completed. In addition, do not identify convictions which have been sealed, expunged, dismissed, or otherwise eradicated by statute or court order, or any information pertaining to an arrest or detention which did not result in conviction, including because of referral to and participation in any pre-trial or post-trial diversion program. Georgia only - do not disclose any information pertaining to any "first offender discharge". Illinois / New Jersey / Oregon / Rhode Island / Rochester, NY / San Francisco, CA only - do not answer this question unless you have already had your initial interview. Massachusetts only - do not answer this question. Minnesota only - do not answer this question unless you have been selected for an interview or a conditional offer of employment has been made. Newark, NJ only - do not answer this question. New York City, NY only - do not answer this question until a conditional offer of employment has been made. Philadelphia, PA only - do not answer this question. Seattle, WA only - do not answer this question. Utah only - do not answer this question with respect to any conviction for a misdemeanor or summary offense. Washington only - answer "yes" only if the conviction was within the last ten (10) years.) *
Yes   No    Exempt (Baltimore, MD / Buffalo, NY / District of Columbia / Hawaii / Illinois / Massachusetts / Minnesota / New Jersey / New York City, NY / Oregon / Philadelphia, PA / Rochester, NY / Rhode Island / San Francisco, CA / Seattle, WA applicant)
Are you currently using illegal drugs? * Yes   No
If YES, which illegal drugs have you recently used?
If YES, when did you recently use each of these drugs?
EDUCATION Please enter your highest level of education.
School Name *   List any special trade or vocational schools attended:
School City * School State/Province *
List any professional or vocational certificates, licenses, or registrations that you currently hold or have held in the past:
Major/Subject *   G.P.A.  
Describe any specialized training, apprenticeship, skills, extracurricular activities, honors, scholarships, appointments, awards, or special recognition that you have received:
Diploma/Degree *  
Please provide your employment history for the past 10 years as follows:
  1. Begin by entering the date range of your most recent job or period of unemployment.
  2. Once you have entered the dates you will be asked to indicate whether you were employed or unemployed between those dates.
  3. Once you have indicated whether or not you were employed during the stated period of time, the required data fields will be indicated by a red asterisk.
  4. Input the requested information into the required fields with the red asterisk.
  5. Click the (+) sign to add the next entry. You may add up to ten periods (date ranges for work or periods of unemployment) to encompass the past ten years.
Be sure to account for all time periods including school, military service and self employment. For periods of unemployment please use the Duties/Details field to explain or comment.
Employment History #1
Were you employed during this period? *   Yes   No If YES, please complete the company information. If NO please explain this gap below.
Starting Date *      
Ending Date     Duties/Details *  
Company Name   Supervisor  
City   State/Province  
Title   Phone   XXX-XXX-XXXX
Reason for Leaving  
Starting Wage Per Hr XX.XX Ending Wage Per Hr   XX.XX
May we contact this employer? Yes   No If NO, please explain.
To add more Employment History click (+)
REFERENCES List three additional business/professional references who have known you for at least one year. DO NOT LIST PERSONAL REFERENCES.
Reference 1
First Name * Last Name *
Email Address
Company / Employer * Phone * XXX-XXX-XXXX Years Acquainted *
Address 1
Address 2
City State/Province Zip/Postal code
Reference 2
First Name * Last Name *
Email Address
Company / Employer * Phone * XXX-XXX-XXXX Years Acquainted *
Address 1
Address 2
City State/Province Zip/Postal code
Reference 3
First Name Last Name
Email Address
Company / Employer Phone XXX-XXX-XXXX Years Acquainted
Address 1
Address 2
City State/Province Zip/Postal code
Please check how you would like your payroll handled upon hire. *
Directly deposited to my bank account. (Direct Deposit form must be submitted to the Employer.)

Deposited onto a pay card. (Enrollment form must be submitted to the Employer.)

Please click on the skill categories that best reflect your experience then place a checkmark next to the specific areas where you feel your skills are the strongest. Please be prepared to provide details of your skills and complete testing if you are considered for a position. *




























Have you held either of these positions? Managerial
Legal Acknowledgements
I understand that Select Staffing does not hire everyone who fills out an application for employment and that all applicants must meet certain general hiring criteria set forth by Select Staffing, such as having the legal right to work in the U.S., appropriate skills, job history, and favorable references. Applicants must also have personal qualities such as being honest, trustworthy, non-violent, and reliable. I understand that Select Staffing does not discuss hiring or placement criteria or hiring decisions with applicants or employees, and that Select Staffing does not discuss termination decisions with employees. I understand that my employment at Select Staffing is on an at-will basis and that I may be terminated at any time, with or without cause, and with or without notice, either at my option or at the option of Select Staffing. In consideration of my employment, I agree to conform to the rules and standards of Select Staffing, as amended by Select Staffing from time to time at their discretion. I further agree that my employment and compensation is for no definite period. Terms and conditions of employment including promotions, change in job duties, locations, and compensation can be changed at the sole discretion of Select Staffing, at any time, with or without cause, advance notice, or stated reason. Select Staffing may warn, reassign, suspend, demote, or terminate any employee in their sole discretion, at any time, with or without cause, advance notice, or stated reason. I understand that no employee or representative of Select Staffing, other than the Chairman & CEO, has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement or condition contrary to the foregoing. Further, the Chairman & CEO of Select Staffing may not alter the at-will nature of this employment relationship unless he signs a written document in which he specifically and clearly indicates the intent to do so.
Please initial authorization and consent for AT-WILL section*
I hereby certify that the information supplied on this application for employment is true and correct to the best of my knowledge, and agree to have any of the statements checked by the Employer, unless I have indicated to the contrary. I authorize the Employer to contact any and all of the references listed (including employers and schools), and I authorize those references to provide the Employer any and all information concerning my previous education and employment and any other pertinent information that any of them may have or know about me. Further, I release all parties, companies, and persons providing such information to the Employer from any liability for any damages that may result from furnishing such information to the Employer as well as from the use or disclosure of such information by the Employer or any of their agents, employees, or representatives. I understand that any misrepresentation, falsification, or material omission of information on this application or during the interview process (regardless of when discovered) may result in my failure to receive an offer or, if I am hired, my immediate termination from employment at any time. I also understand that only a complete application will be considered by Employer and that my failure to submit the application in its entirety may result in my failure to receive an offer of employment.
Please initial authorization and consent for VERIFICATION & RELEASE section*
Select Staffing does not discriminate against their applicants or employees in any manner, and cannot and will not tolerate any form of harassment, including sexual harassment, or discrimination of any type, whether based on sex, race, age, national origin, ancestry, religion, sexual orientation, marital status, or physical or mental disability, toward our employees. Select Staffing is an Affirmative Action and Equal Opportunity Employer. If you believe that you (or another co-worker) have been discriminated against or harassed by a co-worker, supervisor, agent of Select Staffing, or a customer, you should immediately report the facts of the incident and the names of the individuals involved to the Corporate Human Resources Director, who will promptly investigate all claims and take appropriate action. Call 1-800-688-6162 for a direct line, or 877-LISTEN-0 to reach the legal complaint and counseling hotline.
Please initial authorization and consent for DISCRIMINATION AND REPORTING POLICIES section*
In the event there is any dispute between Employer and I relating to or arising out of or relating to my employment or the termination of my employment, which Employer and I are unable to resolve informally through direct discussion, regardless of the kind or type of dispute, Employer and I agree to submit all such claims or disputes to be resolved by final and binding arbitration in accordance with the National Rules for the Resolution of Employment Disputes of the American Arbitration Association within the state of employment. Said disputes may include but are not limited to claims for or under: breach of contract, fraud, misrepresentation, defamation, personal injury, wages, salary, wrongful termination, vacation pay, sick pay, overtime pay, the Federal Labor Standards Act and comparable state laws, the Civil Rights Act of 1964, as amended, 42 U.S.C. section 1981, the Americans with Disabilities Act, laws that prohibit discrimination based on religion, sex, age, color, nationality, physical impairment, disability, medical condition, marital status, or other basis, the Family and Medical Leave Act, the Employee Retirement Income Security Act (ERISA), and state laws regarding unfair competition or unfair business practices.

Any such claims must be submitted on an individual basis only and I hereby waive the right to bring or join any type of collective or class claim in arbitration, in any court, or in any other forum. This class/collective action waiver does not apply to claims brought under the National Labor Relations Act (NLRA). I may challenge the enforceability of this class/collective action waiver under the NLRA or in any other forum, and Employer agrees that it will not retaliate against me or any employee who challenges the enforceability of this waiver; however, Employer reserves all rights to seek to fully enforce the waiver and compel arbitration on an individual basis. Consolidation of claims absent consent of all the parties to the dispute is also prohibited. Any claims must be filed within the statute of limitations applicable to filing such claim in court or in an administrative proceeding. All remedies available through a court or administrative action are available through arbitration. Either party to this agreement may be represented by counsel at any arbitration proceeding and either party retains the right to seek injunctive relief in aid of arbitration.
Please initial authorization and consent for MUTUAL AGREEMENT TO ARBITRATE section
I consent to a pre-employment test to detect the use of illegal or controlled substances, alcohol, or prescription medication without a prescription. I consent to provide a specimen of my urine and/or blood or hair as may be requested in conformity with Select Staffing's policies and procedures. I certify that urine submitted for such a drug screen will be my own. I understand that I have a right to receive a copy of this authorization.

I understand that Select Staffing may require a post-accident screening to test for illegal drugs or controlled substances, alcohol, or prescription medication without a prescription when a work-related accident is reported, in accordance with Select Staffing's policy, and I consent to such a drug screening.

I consent to the release of drug screen results to Select Staffing I also authorize any physician, hospital or clinic who may have examined me previously for drug or substance abuse to release to Select Staffing a complete record of the findings, results or opinions.

I understand and agree that the results of my drug screens may be used in determining my employment eligibility. If I refuse to sign this consent, fail to take a pre-employment or accident-related drug screen, or fail any portion of the test, I will not be considered for employment, or if employed, I will be terminated.

I understand and agree that Select Staffing may release the results of my pre-employment and/or post-accident drug screens to the State Unemployment Department if a claim for unemployment insurance is filed by me or on my behalf.

I agree to hold all parties harmless and not to sue in connection with any aspect of drug screen testing or its effect on my employment status. I understand that if I have any questions about the meaning of the provisions in this authorization and consent or the drug screens, they will be answered on request.
Please initial authorization and consent for AUTHORIZATION AND CONSENT FOR DRUG SCREENING section*
For the duration of my employment, I give permission to Select Staffing to furnish and release to its Workers' Compensation carrier and/or administrator, or any representative thereof, the following information:

1. All medical records pertaining to examinations, treatments, or consultations, including but not limited to, billing records; x-rays and reports; history records; diagnosis and prognosis records; nurses' and doctors' notes and all reports and any psychiatric or mental health records; and all reports relating to diagnosis, care and treatment for drug and alcohol abuse.

2. All employment records pertaining to employment with Select Staffing and any previous employer, including but not limited, to personnel records, payroll records, medical records, and time records.

I understand that the information obtained will be used by Select Staffing's Workers' Compensation carriers and/or administrators for the evaluation and processing of any claims for Workers' Compensation benefits as a result of any work-related injuries. I do not give permission for any other use or re-disclosure of this information.

This Authorization is valid until my claim has been accepted or denied, but in no event beyond one year from the date of my injury. A photocopy of this Authorization is as effective as the original. I understand that I am entitled to a copy of this Authorization.
Please initial authorization and consent for AUTHORIZATION FOR RELEASE OF EMPLOYMENT/MEDICAL RECORDS section*
FCRA Disclosure
As part of the application process for employment at the Employer, I understand that the Employer may request my consent to seek and obtain consumer reports / investigative reports about me as defined in the Fair Credit Reporting Act (FCRA). These investigative reports may include, but is not limited to names and dates of previous/current employment, work experience, work habits, characters, work performance, general reputation, workers compensation claims, criminal history records (from local, state, federal, international and other law enforcement agencies' records), sexual offender's lists, wants and warrants records, motor vehicle records, military records, educational verification, license verification, credit history, credit worthiness, civil case, OIG/GSA, OFAC/patriots act, any sanction lists, FBI finger printing and drug testing. I understand that these records may be used for the eligibility and qualification of my employment.
Please initial to indicate that you have read the FCRA Disclosure *
I hereby certify that the information supplied on this application for employment is true and correct to the best of my knowledge, and agree to have any of the statements checked by Select Staffing, unless I have indicated to the contrary.

By signing I acknowledge that I have read and understood all of the above statements.

Please enter your name in the same format that you sign your name
Signature Date*
(i.e. MM/DD/YYYY)
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