First Name*
Last Name*
Address*
City*
State*
Zip Code*
Phone*
Email*
Date of Birth*
Social Security Number
Date Available to Start*
English Level* HighMediumLow
Do you have work restrictions?* NoYes
If "Yes" to restrictions, please explain:
Do you have upcoming vacations or appointments?* NoYes
If "Yes" to vacations/appointments, please explain:
Can you work in a cold, hot, and humid environment?* YesNo
Can you lift heavy weight?* YesNo
Are you currently employed?* NoYes
If yes, where?
Relevant experience (forklift, maintenance technician, etc.)?* NoYes
If "Yes" to relevant experience, which?
High School
School Name
Address
Did you graduate? YesNo
Date (Graduation)
Diploma
University/College
University Name
Diploma/Degree
Full Name*
Relationship*
Company
Phone (Company)
Address (Company)
Supervisor
Job Title
Starting Salary
Final Salary
Start Date
End Date
Responsibilities
Reason for Leaving
May we contact your previous supervisor? YesNo
Branch
Rank at Discharge
Type of Discharge
Authorization for Background Check: I hereby authorize Hire Dynamics Staffing Solutions LLC to investigate my background and qualifications for the purpose of evaluating whether I am qualified for the position for which I am applying. I understand that Hire Dynamics Staffing Solutions LLC will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize such investigation by information services and outside entities of the company's choice. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application for employment will not be processed further.
Disclaimer: I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature (Accepting both clauses above)*
Full Legal Name (Confirmation)*
Signature Date*
