Short Application for Employment - Excel

					                                 Piedmont Staffing LLC
                               Application for Employment - Short Form
                                                Personal

Last Name_____________________First Name______________________ Social Security #______________

Address______________________________________City/State___________________________________

Zip Code______________Telephone Number___________________Are you over 18 yrs old _____Yes_____No
                                          Education

High School Graduate/GED______Yes______No       Name of last High School__________________________

Years of College _________ College Attended_____________________Field of Study___________________

Additional Certificates or Courses earned________________________________________________________
                                               Military Service

US Military Service ______Yes______No       Branch____________________________Rank_______________
                                             Employment History
                        List all periods of employment starting with most recent first
Company Name________________________________Date Started____________Date Ended_____________

Job Title_________________________Base Pay Start____________Base Pay End______________________

Duties and Responsibilities____________________________________________________________________

Supervisors Name________________________ Reason for Leaving___________________________________


Company Name________________________________Date Started____________Date Ended_____________

Job Title_________________________Base Pay Start____________Base Pay End______________________

Duties and Responsibilities____________________________________________________________________

Supervisors Name________________________ Reason for Leaving___________________________________


Company Name________________________________Date Started____________Date Ended_____________

Job Title_________________________Base Pay Start____________Base Pay End______________________

Duties and Responsibilities____________________________________________________________________

Supervisors Name________________________ Reason for Leaving___________________________________

                                         Professional References
           List supervisors or managers that we may contact who have knowledge of your ablities
        Name and Title                     Place of Employment            Contact Phone Number




                                           Continue on Back
Have you ever been convicted of a Felony or misdemeanor besides a minor traffic violation? A conviction of a
misdemeanor or a felony does not automatically bar you from employment. All circumstances will be considered.
Please describe in detail any felony or misdemeanor convictions below.

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________



I certify to Piedmont Staffing LLC, that the information contained in this application is correct to the best of my
knowledge. I understand falsification of this information or omission of material is grounds for termination of my
employment at any time. Furthermore, I agree to the following:

1. I must produce applicable documentation showing that I am a United States citizen or alien lawfully authorized
to work in the United States, within a time frame specified by Piedmont Staffing to meet the Immigration Reform
and Control Act of 1986 requirements.

2. I understand that my employment will be contingent upon the results of any substance abuse test that
Piedmont Staffing LLC deems necessary. These tests are not limited to but including all tests that are required by
any workplace which contracts labor from Piedmont Staffing LLC. Prior to any such test, I agree to release the
results of the test to Piedmont Staffing LLC.

3. I authorize Piedmont Staffing LLC, to contact my prior employers, references and educational institutions listed
on this application. Furthermore, my prior employers, references and educational institutions are authorized to to
release any and all information that they deem pertinent for my employment. I release all persons or entities from
all liability for any damages that may result from furnishing information to Piedmont Staffing LLC and all of its
employees from all liability for any damaage that may result from Piedmont Staffing LLC's reliance on the
information furnished.

I fully understand that if I fail to comply with any of the requirements set forth above, my employment may be
terminated without liability at any time.

In consideration of my employment, I agree to conform to Piedmont Staffing LLC polices, rules and regulations. I
understand and agree that my employment is at-will, therefore, my employment, benefits and compensation can
terminate with or without cause for any legal reason. Such employment can terminate with or without notice, at
anytime, at my option or Piedmont Staffing LLC's option.



Signature___________________________________________ Date__________________________________



Comments: (For office use only)

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posted:8/23/2011
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Description: Short Application for Employment document sample