Employment Application Form

Employment Application

Social Security Number*

Home Address*

City*

State*

Zip Code

Cell Phone & Carrier*

Alternate Phone*

Email

Emergency Contact*

Emergency Phone*

Employment History

Employee Requirements and Information

TYPE OF WORK INTERESTED IN*

WAGE RANGE (BE ACCURATE)*

DO YOU HAVE TRANSPORTATION AND DRIVERS LICENSE*

HAVE YOU EVER BEEN CONVICTED OF A FELONY-THIS DOES NOT DISQUALIFY FOR WORK*

ARE YOU WILLING TO TAKE A DRUG TEST*

Education/Certification

Acknowledgements and Conditions of Employment

Please review the following information, sign and date below to acknowledge you understand and accept Skilled Staff's initial condition of employment policies. A failure to comply could be detrimental to Skilled Staff and result in unfavorable consequences:

I understand and agree that Skilled Staff is an equal opportunity employer. Skilled Staff is to provide a fair and equal employment opportunity for all associates and job applicants regardless of race, color, religion, national origin, gender, sexual orientation, age, marital status or disability. Skilled Staff hires and promotes individuals solely on the basis of their qualifications for the job to be filled.
I understand the Skilled Staff takes their responsibility as my employer seriously and has gone to great lengths to establish a safe work environment. If injured on the job, I agree to notify Skilled Staff immediately. Skilled Staff has a network of preferred medical facilities that will expedite service in case of an emergency. In our experience, it is the fastest and most cost effective route for proper treatment. These facilities have our information on file and will attend to you immediately upon coordination with a Skilled Staff representative.
If I sustain an injury on the job, I will inform the client company and Skilled Staff immediately, who will then coordinate with the client company and myself, the proper procedures for treatment and reporting of the accident.
I agree to communicate to Skilled Staff if I am unable to perform duties and responsibilities of my job description or assignment. I agree to notify Skilled Staff if my job description changes once I am working. If I am asked to perform risky injury prone work, asked to drive a vehicle, or work around hazardous waste, I will confidentially notify Skilled Staff.
I understand that Skilled Staff has a strict "Drug Free Workplace Policy" and I understand that violation of this policy will result in termination of employment. I agree to submit a drug and alcohol test upon request by Skilled Staff for pre-employment, random, and post-accident drug testing.
I understand and agree that it is my responsibility to complete any job assignment I accept. I understand that if I do not complete or promptly notify Skilled Staff of my inability to complete an assignment, or I do not report for my assignment, then Skilled Staff may assume I have voluntarily quit, and will not be eligible for unemployment benefits. When I complete my assignment I must notify Skilled Staff so they ample time to reassign me to a new job. If I do not contact them after the completion of an assignment, I will not eligible for unemployment benefits.
I understand that Skilled Staff will deal promptly with all legitimate Workers' Compensation claims. A thorough evaluation is done by a number of medical professionals to ensure the injury is handled immediately. I also understand that Skilled Staff prosecutes all fraudulent Workers' Compensation claims to the fullest extent of the law.
I understand that I have been hired by Skilled Staff and accepted an assignment a onetime $20 processing and application fee will be deducted from my from my first paycheck.
I understand that my employment with Skilled Staff enables me to work with some of the best organizations in the market. My work ethic is a representation of Skilled Staff and should do my best to represent Skilled Staff well. Skilled Staff understands that not all positions are a perfect fit for the employee. I agree to communicate any issues that arise in the workplace and give one week notice before I terminate my employment. This gives Skilled Staff ample time to service our clients in a professional manner. If I do not give one week notice before I leave my position, or I do not call in or do not show up for work at any time with communication to Skilled Staff, or I am fired for attendance issues, I understand may pay will be reduced to minimum wage for all unpaid hours.
I understand Skilled Staff's requirements for receiving information, documenting hours worked, the method of providing this information, and the time frame for me to provide this information. I understand that Skilled Staff will not recognize or pay any hours worked by me without proper documentation verifying hours worked.
I WILL NOT DISCUSS MY PAY RATE WITH ANY OTHER SKILLED STAFF EMPLOYEES, OR CLIENT EMPLOYEES. Failure to comply with this will result in immediate termination and make me ineligible for rehire with Skilled Staff. I also understand that if I am ever overpaid in error that Skilled Staff has the authority to withdraw the overpayment from my bank account.
I am capable for the duration of my shift. I am capable of reaching above my head and also picking up things that are below my waist. I am capable of lifting thirty pounds.
There are no prior obligations that will prevent me from getting to work for the next 90 days (this includes appointments for myself or family members, court dates, health matters, vacation, etc.)
I am telephone accessible and have a reliable form of transportation. Transportation issues will not prevent me from arriving to work every day (this includes getting to work in poor weather conditions.
I have adequate care for my children, including a back-up plan if my child has a minor illness. Childcare will not interfere with my attendance at work. I will provide a doctor's note if I miss work due to my child being ill. (We at Skilled Staff, understand that there are times when our employees must tend to an ill child, and we are sympathetic to hat.)
If for some unexpected reason, such as an emergency or illness, I can not make it to work or will be late, I will contact Skilled Staff at my local office as well as my supervisor at the client company. If I am absent due to illness, I will need to provide a doctor's note within 24 hours of the missed time.
I understand that may pay will drop to minimum wage ($7.25) for any unpaid hours if:
1. I do not give a one week notice to Skilled Staff before quitting
2. No Call/No Show for work.
I understand that as an hourly employee, I am not entitled to holiday pay unless specified by the client for whom I am working, and it is documented on my time sheet.
Skilled Staff intends to obtain information about you for employment purposes from an investigative consumer reporting agency or consumer credit reporting agency. Thus, you can expect to be the subject of "investigative consumer reports" and "consumer credit reports" obtained for employment. Such reports may include information about your character, general reputation, personal characteristics, and mode of living. With respect to any investigative consumer report from an investigative consumer reporting agency (ICRA), the Company my investigate the information contained in your employment application and other background information about you, including but not limited to obtaining a criminal report, verifying references, work history, your social security number, your educational achievements, licensure, and certifications, your driving record, and other information about you, and interviewing people who are knowledgeable about you. The results of this report may be used as a factor in making employment decisions.
I authorize Skilled Staff to conduct a background check

I have read and fully understand the above statements regarding Skilled Staff's Policies and Procedures and agree to the same. I understand that failure to comply with these policies and procedures could lead to my termination and may jeopardize my insurance benefits.

Date*