APPLICATION           Office       Industrial
Name: Last, First, Middle
 Address: Street, Apt., City, State, Zip
U.S. Citizen Legal Right to Work in U.S. Social Security Number
Are you presently 18 years of age or older?
Yes No		 Home Phone
Other Phone
Referred By Today's Date
In case of Emergency, Notify: Special Emergency Instructions:
Would you be willing to take a drug test if it were a condition of employment? Yes No

Which type of transportation do you use?
Car Available Public Transportation 		Have you ever been convicted of a criminal offense other than a minor traffic violation? Yes No
If yes, give details:
Driver's License Number State             Expires             Class
Enter highest level of education:           Major course of study:
Name, city and state of highest level school attended:

Dates Attended: Degrees Received:
Work History
List Current or most recent first
From
To 		Employer               
Address 		Type Business
Position
Phone
 Your Duties
 Reason for Leaving
 May we contact?
Yes No
Your Supervisor's Name
 Were you part-time or full-time?
Full-time Part-time		 What was your ending pay rate?
From
To 		Employer                 
Address 		Type Business
Position
Phone
 Your Duties
 Reason for Leaving
 May we contact?
Yes No
Your Supervisor's Name
 Were you part-time or full-time?
Full-time Part-time		 What was your ending pay rate?
From
To 		Employer               
Address 		Type Business
Position
Phone
 Your Duties
 Reason for Leaving
 May we contact?
Yes No
Your Supervisor's Name
 Were you part-time or full-time?
Full-time Part-time		 What was your ending pay rate?
 
Check the areas below in which you have experience and would like assignments

General Office
Clerk
Receptionist/
      Switchboard
Filing

Equipment
Fax
Phone System
Make, Model & number
of lines:

 Typing
General
Forms
Statistical
Legal
Medical

Secretarial
General
Executive
Legal
Medical
Shorthand
 Accounting
Payroll
Credit/
      Collections
Payables/
      Receivables
Bookkeeping
Bank Teller

Equipment
Calculator
      Visual
      Touch
 Marketing
Sales
Demos
Shopper
Telemarketing
Detailer
      Merchandiser
Sampler/
      Couponer
Customer
      Service
 
Office Automations
Equipment Experience

 Software Experience
 
For the areas below in which you have experience and would like assignments, note the number of years experience and record any important details in the space provided beside each skill.
Industrial Skills
Assembly Line Years       Important Details:
Forklift Years Important Details:
Inspection Years Important Details:
Material Handling Years Important Details:
Stock Clerk Years Important Details:
Truck Driver Years Important Details:

Machine Skills
CNC/NC Machinist
      (requiring setup exp)		 Years Important Details:
Machine Operator
      (no setup)		 Years Important Details:
Machinist
 Years Important Details:
Millwright
 Years Important Details:
Printing Press
      Operator
 Years Important Details:
Sheet Metal
      Fabricator
 Years Important Details:
Tool and
      Die Maker
 Years Important Details:


Benchwork Skills
Electronic
     Assembler
 Years Important Details:
Power Hand
      Tools
 Years Important Details:
Semi-Conductor
      Assembler
 Years Important Details:
Soldering/
      Wiring
 Years Important Details:


Structural Skills
Metal Worker
 Years Important Details:
Electrician
 Years Important Details:
Painter
 Years Important Details:
Pipe Fitter
 Years Important Details:
Plumber
 Years Important Details:
Tradesman Helper
 Years Important Details:
Welder
 Years Important Details:

Other Skills
Food Handling
 Years Important Details:
Foreman/Supervisor
 Years Important Details:
Janitor
 Years Important Details:
Landscaping
 Years Important Details:
Mechanic
 Years Important Details:
Other Skills
 Years Important Details:

Other Helpful Skills
Shopmath
 Years Important Details:
Metric Scale
 Years Important Details:
Keyboard
 Years Important Details:
Machine Measure
      Tools
Years Important Details:
Do you hold a Journeyman License? Yes No      If yes, what trade?

Have you completed a Safety Training Course? Yes No       If yes, when?
What was the name of the course?

Enter your Questions and/or Comments here:




EMPLOYMENT AGREEMENT


I hereby authorize Nan Vaden's Temple Temps to ask the companies and/or persons listed as references on this application any questions concerning me, my work skills, work habits and/or my conduct on the job, unless I have indicated on this application that I do not want the reference to be contacted.

I understand that the term of my employment shall be limited to the length of any temporary assignment I accept and I further understand that Nan Vaden's Temple Temps is not an employment agency. I agree that my employment may be terminated by Nan Vaden's Temple Temps any time without liability of wages or salary except those wages I earned on a temporary assignment prior to my termination.

When employed by Nan Vaden's Temple Temps, I agree that if I make claims against the said Temple Temps for personal injuries at any time, I will submit myself to be examined by a doctor or doctors of Temple Temps choice as often as may be requested.


Date submitted:_______________   Signature_____________________________________