JOIN OUR PASSIONATE AND DYNAMIC TEAM primeratestaffing_job_form Personal informationsEducationReferencesPrevious EmploymentMilitary ServiceDisclaimer, Attachments and Submission Personal informationsFirst NameMiddle NameLast NameAddressApartment/Unit #CityStateZip CodePhoneEmailDate AvailableSocial Security N°Desired Salary ($)Position Applied forAre you a citizen of the United States ? YES NOIf no, are you authorized to work in the U.S.? YES NOHave you ever worked for this company ? YES NOIf yes, when ?Have you ever been convicted of a felony? YES NOIf yes, explainPreviousNextEducationHigh SchoolAddressFromToDid you graduate? YES NODiploma-------------------------------------------CollegeAddressFromToDid you graduate? YES NODiploma-------------------------------------------OtherAddressFromToDid you graduate? YES NODiplomaPreviousNextReferencesPlease list three professional references.Full NameRelationshipCompanyPhoneAddress-------------------------------------------Full NameRelationshipCompanyPhoneAddress-------------------------------------------Full NameRelationshipCompanyPhoneAddressPreviousNextPrevious EmploymentCompanyPhoneAddressSupervisorJob TitleStarting Salary ($)Ending Salary ($)ResponsibilitiesFromToReason for LeavingMay we contact your previous supervisor for a reference? YES NO-------------------------------------------CompanyPhoneAddressSupervisorJob TitleStarting Salary ($)Ending Salary ($)ResponsibilitiesFromToReason for LeavingMay we contact your previous supervisor for a reference? YES NO-------------------------------------------CompanyPhoneAddressSupervisorJob TitleStarting Salary ($)Ending Salary ($)ResponsibilitiesFromToReason for LeavingMay we contact your previous supervisor for a reference? YES NOPreviousNextMilitary ServiceBranchFromToType of DischargeRank at DischargeIf other than honorable, explain :PreviousNextDisclaimer, Attachments and SubmissionAdditional Documents Copies - Upload online: Copy of Drug Test Copy of Back Ground Check Copy of Valid C.N.A, P.C.A, H.H.A Certification. Basic Life Support / C.P.R TB Screen / PPD Chest X-Ray Copy of SSN Work Authorization Immunization Records COVID Cards Within 12 months Physical Records Auto Insurance Flu Vaccine Resume W2 I-9 Form Select the required files to attach to your request.--- Click here and select all required files --- I certify that my answers are true and complete to the best of my knowledge. I have read and accept the NON-COMPETE AGREEMENTS.If this application leads to employment, I understand that false or misleading information in my application or interview may lead to job dismissal or cancellation of employment. Previous Submit
