Complete Employment Application – Distinguished Staffing

Please Complete and Submit

First Name

Middle Name

Last Name

Address

City

State

Zip Code

Best Number To Reach You

Email Address

DOB

Social Security Number

Are you legally authorized to work in the United States?*

Are you legally authorized to work in the United States?

yes no

Do you have a Visa to work in the United States? *

yes no

Do you have reliable transportation? *

yes no

Can you perform the essential functions of the job you seek with or without reasonable accommodation? *

yes no

Can you work 8 hours at a time ? *

yes no

Desired Pay

Desired Position

Shift Available

Will you be absent in the next 60 days? *

yes no

If yes, please explain

Have you ever been convicted of a crime? *

yes no

If yes, please explain

High School

City

State

Did you graduate?

yes no

College

City

State

Did you graduate?

yes no

Trade School

City

State

Did you graduate?

yes no

Most Recent Employer

Postion

Number of Years

Previous Employer

Postion

Number of Years

Previous Employer

Postion

Number of Years

Upload Resume

I confirm that all the information provided is true and correct to the best of my knowledge. *

Please Complete and Submit

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Location

Business Hours