Download PPApp for TempStaffing_1

Application for Employment
Name
Social Security
Address
Apt #
Address 2:
Home Phone
City:
State:
Zip:
Name
Emergency Contact information
Cell Phone
Relationship
Phone #
References
Please provide three employment references with whom you have worked with in the past.
Name
Phone
Relationship
Years known
May we contact your current employer?
Have you ever been terminated from a job? If so please explain.
1595 Peachtree Parkway • Suite 204-214 • Cumming, GA 30041
678.965.5690 OFFICE • 678.965. 5691 FAX • 678.907.6972 CELL
Version 2011021001
1
Employment History
Please provide name, address and phone number of employers (do not supply the phone number
of any employer you do not want us to contact).
Most recent or current employer
Dates of employment
Salary Reason for
Leaving
Previous employer
Dates of employment
Salary
Reason for
leaving
Previous employer
Dates of employment
Salary
Reason for
leaving
What position are you applying for?
Do you have any industry relevant training or certificates?
I authorize Premier Placements, LLC to contact my references and previous employers for the
purpose of confirming employment. I further acknowledge and agree to a criminal background
check for the purpose of obtaining employment. I understand that Premier Placements, LLC is a
Drug Free Company and that I may be submitted to random drug testing.
Name
Date
____________________________________________
_________________
1595 Peachtree Parkway • Suite 204-214 • Cumming, GA 30041
678.965.5690 OFFICE • 678.965. 5691 FAX • 678.907.6972 CELL
Version 2011021001
2