Applicant InformationFull Name First Middle Last Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneEmail Date Available Date Format: MM slash DD slash YYYY Social Security NoDesired SalaryPosition Applied forAre you a citizen of the United States?YesNoIf no, are you authorized to work in the U.S.?YesNoHave you ever worked for this company?YesNoIf yes, when?Have you ever been convicted of a felony?YesNoIf yes, explainEducationHigh SchoolAddressFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Did you graduate?YesNoDiploma CollegeAddressFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Did you graduate?YesNoDegree OtherAddressFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Did you graduate?YesNoDegreeReferencesPlease list three professional references.Full NameRelationshipCompanyPhoneAddress Full NameRelationshipCompanyPhoneAddress Full NameRelationshipCompanyPhoneAddressPrevious EmploymentCompanyPhoneAddressJob TitleSupervisorStarting SalaryEnding SalaryResponsibilitiesFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference?YesNo CompanyPhoneAddressJob TitleSupervisorStarting SalaryEnding SalaryResponsibilitiesFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference?YesNo CompanyPhoneAddressJob TitleSupervisorStarting SalaryEnding SalaryResponsibilitiesFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Reason for LeavingMay we contact your previous supervisor for a reference?YesNoMilitary ServiceMilitary ServiceFrom Date Format: MM slash DD slash YYYY To Date Format: MM slash DD slash YYYY Rank at DischargeType of DischargeIf other than honourable, ExplainUpload ResumeDisclaimer and SignatureConsent* 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. SignatureDate Date Format: DD slash MM slash YYYY 1 DIRECTION EMPLOYMENT SERVICES SAFETY AGREEMENT* Select All ASSOCIATE will only work on jobs for which they have been assigned and trained. Any variance must be reported to 1 DIRECTION before work begins. ASSOCIATE is responsible for Safety Program implemented. Management, and training as required by OSHA standards. All Assigned Employees will be oriented/trained in all necessary safety-related programs such as: Hazard Communication (MSDS), Noise Hazard, First Aid, Lock-Out/Tag-Out, Respirator Programs, and Fire Procedures. ASSOCIATE will ensure that they are wearing all appropriate safety equipment at all times. ASSOCIATE will immediately notify 1 DIRECTION if any Assigned Associate will be required to wear respirators or any other such PPE (personal protective equipment) which requires fit testing, medical evaluation, a written program, training, etc. CLIENT will forward a copy of all said documents to 1 DIRECTION. ASSOCIATE will ensure that Assigned Employees have been certified to operate any powered equipment as required. Certification must be Powered-Industrial-Truck-specific as required by OSHA. ASSOCIATE will include all Assigned Employees in any safety meetings attended by any workers in similar positions. ASSOCIATE consents to site inspections by members of 1 DIRECTION in areas where any Assigned Employees work. 1 DIRECTION will provide reasonable notice of the visit during normal business hours and complies with any requirements of visitors. ASSOCIATE will immediately notify 1 DIRECTION in the event of accident or injury of an Assigned Employee. 1 DIRECTION will coordinate appropriate medical treatment (unless it is an emergency) with physicians from our workers compensation panel. ASSOCAITE will allow a qualified representative of 1 DIRECTION to investigate and obtain a report after an accident or injury to insure proper disposition of possible worker's compensation claims. This investigation will not be used for any purpose beyond proper disposition of possible worker’s compensation claims. ASSOCAITE will immediately notify 1 DIRECTION in the event any Assigned Employee act intoxicated or act in a suspicious manner. Dear Valued Associate, Our goal is to provide you with the best employment possible, to employ you in a safe work environment for the duration of your assignment. To do so, we want to have a mutual understanding of safety and on-the-job injury procedures, practices and philosophies
