* = Required fields |
| As part of the application process, Employer Flexible Resources may conduct background checks on employees. You will be asked to complete an Authorization of Release form for this purpose. |
| * |
Initial your understanding of this statement.: |
|
| Employer Flexible Resources is an Equal Opportunity Employer. It is our policy to abide by all federal, state, and local laws prohibiting employment discrimination based solely on a person’s race, color, religious creed, sex, national origin, ancestry, citizenship status, pregnancy, physical disability, mental disability, age, military status or status as a Vietnam-era or special disabled veteran, marital status, registered domestic partner status, gender (including sex stereotyping), medical condition (including, but not limited to, cancer related or HIV/AIDS related), sexual orientation, or any other protected status except where a reasonable bona fide occupational qualification exists. |
| General Information |
| * |
Application Date: |
|
| * |
Date Available To Work: |
|
| * |
Position Applied For: |
|
| * |
Last: |
|
| * |
First: |
|
| * |
Middle: |
|
| * |
Desired Wage: |
|
| * |
Desired Work Type: |
|
|
If Part Time, Specify Hours or Days Available: |
|
| Current Address |
| * |
Current Street: |
|
|
Current Apt.: |
|
| * |
Current City: |
|
| * |
Current State: |
|
| * |
Current ZIP: |
|
| * |
How Long At Current Address?: |
|
| Previous Address |
|
Previous Street: |
|
|
Previous Apt.: |
|
|
Previous City: |
|
|
Previous State: |
|
|
Previous ZIP: |
|
|
How Long At Previous Address?: |
|
| * |
Primary Phone Number: |
|
| * |
Primary Phone Number Type: |
|
|
Secondary Phone Number: |
|
|
Secondary Phone Number Type: |
|
| * |
Email: |
|
| * |
Emergency Contact Name: |
|
| * |
Emergency Contact Number: |
|
| * |
Are you capable of performing the essential duties of the position you are being hired or interviewed for, with or without reasonable accommodation?: |
|
|
What accommodations if any would be necessary?: |
|
| * |
Can you, after employment, submit verification of your legal right to work in the United States?: |
|
| * |
Have you previously held employment with Employer Flexible HR, Inc. and / or the Employer Flexible HR, Inc. client company you are applying for?: |
|
| If yes, give dates: |
|
Previous Employment From: |
|
|
Previous Employment To: |
|
| Education and Training |
|
High School / GED - School Name: |
|
|
High School / GED - City, State: |
|
|
High School / GED - Degree / Diploma: |
|
|
High School / GED - Degree Received: |
|
|
College - School Name: |
|
|
College - City, State: |
|
|
College - Degree / Diploma: |
|
|
College - Degree Received: |
|
|
Graduate School - School Name: |
|
|
Graduate School - City, State: |
|
|
Graduate School - Degree / Diploma: |
|
|
Graduate School - Degree Received: |
|
|
Trade School - School Name: |
|
|
Trade School - City, State: |
|
|
Trade School - Degree / Diploma: |
|
|
Trade School - Degree Received: |
|
|
List any other education, training, special skills, certificates, or licenses that you possess related to the position: |
|
|
List any machines, equipment, or software on which you are qualified and experienced in operating: |
|
| Record of Previous Employment |
| Please list the names of your present employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references. |
| Current or Previous Employer |
|
Current or Previous Employer: |
|
|
Address: |
|
|
City, ST, ZIP: |
|
|
Telephone: |
|
|
Employed From: |
|
|
Employed To: |
|
|
Pay Start: |
|
|
Pay Final: |
|
|
Your Title or Position: |
|
|
Description of Duties: |
|
|
Exact Reason for Leaving: |
|
|
May we contact this employer?: |
|
|
Supervisor's Name and Title: |
|
| Previous Employer |
|
Previous Employer: |
|
|
Address: |
|
|
City, ST, ZIP: |
|
|
Telephone: |
|
|
Employed From: |
|
|
Employed To: |
|
|
Pay Start: |
|
|
Pay Final: |
|
|
Your Title or Position: |
|
|
Description of Duties: |
|
|
Exact Reason for Leaving: |
|
|
May we contact this employer?: |
|
|
Supervisor's Name and Title: |
|
|
Employment Gaps: |
|
| Criminal Record Disclosure |
| Answering “YES” to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the matter of the violation, land rehabilitation will be taken into account, (Do not include minor traffic citations and arrests or convictions which have been sealed or expunged in answering this question.) |
| Are you currently or have you ever been a party to any misdemeanor or felony criminal matter, other than minor traffic safety violations for which no arrest was made, in which you were charged, convicted, served probation, participated in deferred adjudication, or other program to avoid a conviction, or made restitution or participated in pre-trial diversion or other program to avoid prosecution? This includes if you have ever been arrested for any matters for which you are out on bail or on your own recognizance pending trial. |
| * |
misdemeanor or felony criminal matter: |
|
| Criminal Records: if you answered Yes to either of the above two questions, please provide the date(s) and describe that criminal record so the individual circumstances can be considered. |
|
Criminal Records: |
|
Employer Flexible Resources POLICIES AND PROCEDURES
YOU MUST READ AND UNDERSTAND. ANY QUESTIONS ABOUT THESE POLICIES AND PROCEDURES NEED TO BE ASKED AS YOU READ THE FOLLOWING:
Employer Flexible Resources Is Your Employer. Whether you are still on short-or long-term assignment with our customer, you are still an Employer Flexible Resources employee. Call your Staffing Specialist to tell us if:
- You’re going to be late or unable to report to work. Not showing up for work without first telephoning us could be cause for termination.
- The work you’re asked to do is substantially different from the work described to you by your Staffing Specialist.
- The work environment appears unsafe.
- You’re sick or injured on the job, or feel you can’t complete a job.
- You’re unavailable for a period of time. Let us know in advance if you’re planning a vacation or time off for any reason.
- You’ve changed your address or telephone number.
- You’ve learned new skills that may qualify you for more assignments or higher pay.
- Your assignment ends. You must call us within 48 hours to let us know of your availability for your next assignment. To maintain employee status with Employer Flexible Resources, you must keep us informed as to your availability. When you complete an assignment, notify Employer Flexible Resources by phone within 48 hours. You are then required to call us weekly to inform us of your availability status. If we do not hear from you within 48 hours of an assignment completion, and every week thereafter until assignment is started, we will consider you unavailable for work and to have voluntarily resigned from employment. Further assignments may not be offered.
- ALL INJURIES MUST BE REPORTED TO Employer Flexible Resources IMMEDIATELY AT 281-444-0900 AND YOUR SUPERVISOR ON YOUR ASSIGNMENT.
- ALL ISSUES DEALING WITH HARRASMENT MUST BE REPORTED TO Employer Flexible Resources IMMEDIATELY AT 281-444-0900.
- ALL TIME CARDS MUST BE TURNED IN FOR THE WORK WEEK BY NOON (12:00PM) THE FOLLOWING MONDAY TO ENSURE PAYCHECK AVAILABILITY ON FRIDAY.
- WORK WEEKS ARE MONDAY THROUGH SUNDAY.
- CHECKS WILL BE AVAILABLE FOR PICK UP AFTER 1PM ON FRIDAY. IF YOU NEED YOUR CHECK TO BE RECUT FOR ANY REASON, THERE WILL BE A $25 FEE ASSOCIATED WITH THIS PROCESS, UNLESS YOU CAN PRODUCE THE ORIGINAL CHECK.
I CERTIFY THAT ALL THE INFORMATION I HAVE PROVIDED ON THIS FORM IS TRUE AND ACCURATE, AND I HAVE READ, UNDERSTAND, AND AGREE TO ABIDE BY THE POLICIES LISTED ABOVE. |
| * |
Signature of Applicant: |
|
| * |
Signature Date: |
|
|
|
|
