Thank you for taking the time to apply with Modern Staffing!
We look forward to working with you!

Name (Legal First, Last Name, Middle Name Suffix) *

APPLICATION FORM

EMPLOYMENT STATUS:

Full Name *

Name (Legal First, Last Name, Middle Name Suffix)

I acknowledge and agree that my employment with MODERN Staffing does not commence until I begin my assignment through MODERN Staffing at a Client of MODERN Staffing. I understand that submittal of a resume, completion of an application or completion of an interview does not constitute an agreement between MODERN Staffing and myself that MODERN Staffing will assign or attempt to assign me work.

PERSONAL INFORMATION:

Name (Legal First, Last Name, Middle Name Suffix) *

Primary Number *

Secondary Number

Street Address *

City/State *

ZIP Code *

Email Address *

Are you eligible to work in US? *

AVAILABILITY (check all that apply) *

Do you have reliable transportation to and from work? *

Do you have your own safety shoes? *

Do you have your own safety glasses? *

Are you able to perform the job you are applying for with or without reasonable accommodations? *

RECORD OF EDUCATION:

Name of High School attended

The year completed

Name of vocational school / college / university attended:

The year completed

REFERENCES (Please provide only job references)

Name of Supervisor	Company Name	Phone Number
Name of Supervisor	Company Name	Phone Number
Name of Supervisor	Company Name	Phone Number

Applicant’s Release (Please read Carefully)

All information provided by me in support of my application for employment is true and correct to the best of my knowledge. I understand that misrepresentation or omissions will constitute sufficient grounds for rejection or for subsequent dismissal if I am hired. I understand that I may become aware of confidentiality information regarding the policies and procedures of MODERN Staffing. I also understand that I am expected to keep all information private and confidential and not to disclose information without direct permission. I hereby authorize any current or former employer, school, person, firm, corporation or government agency to answer any and all questions and to release or provide information within their knowledge or records, and I agree to hold any or all of them blameless and free of any liability for releasing any truthful information within their knowledge or records. MODERN Staffing is hereby authorized to release to any other firm or person with whom I may seek employment, any or all information concerning my employment or application and I agree to hold MODERN Staffing blameless and free of any liability for releasing such information.

Candidate Name *

Candidate Agree Date *

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APPLICATION FORM

REFERENCES (Please provide only job references)

Applicant’s Release (Please read Carefully)

Thank you!