REGISTER HERE

Thank you for taking the time to complete our online registration form. Please fill out the form below as completely as possible. Registration will take approximately 15 minutes to complete. All information is required.
Personal Information

Are you at least 18 years of age and do you have the legal right to work in the United States?
Yes No
First Name
Middle Name
Last Name
Nickname / Preferred Name
Street Address / Apartment
City
State
ZIP Code
Home Phone
                                  - Area code + phone
Other Phone
- Area code + phone
Email Address


Resume - (Cut and paste here. Your resume must be saved as .rtf (Rich Text Format) in order for us to import it.)  If you are interested in a specific job, enter the job id# at the top of this box.

 
Availability

Are you willing to work temporary?
Yes No
Are you looking for a full-time career position?
Yes No
Are you looking for contract positions?
Yes No
When are you available to start?
What weekday hours are you available?
What weekend hours are you available?
Hours willing to work in a week?
Are you willing to work overtime?
Yes No
What is the minimum pay you desire? Hourly rate or annual salary
How much notice will you need if a position is offered to you?
How many miles are you willing to travel to a position?
This question determines who is responsible for reviewing this application in eApprovals?
 
    
Education


Enter most recent -
(Do not enter start and end date if the most recent is high school)
Name of School
Type of school
Street Address
City
State  
ZIP Code
Degree
Major Study Area
Other Studies

Recent Employment

(List most recent first)
Company Name
Street Address
City
State  
ZIP Code
Employers Phone
Supervisor Name
Job Title
Job Duties (you may cut and paste from your resume here.)
Start Date (Month / Year)
End Date (Month / Year)
Start Wage

Hourly rate or annual salary
End Wage

Hourly rate or annual salary
May we contact this employer for a reference check?
Yes No
Company Name
Street Address
City
State  
ZIP Code
Employers Phone
Supervisor Name
Job Title
Job Duties (you may cut and paste from your resume here.)
Start Date (Month / Year)
End Date (Month / Year)
Start Wage

Hourly rate or annual salary
End Wage

Hourly rate or annual salary
May we contact this employer for a reference check?
Yes No
Company Name
Street Address
City
State  
ZIP Code
Employers Phone
Supervisor Name
Job Title
Job Duties (you may cut and paste from your resume here.)
Start Date (Month / Year)
End Date (Month / Year)
Start Wage

Hourly rate or annual salary
End Wage

Hourly rate or annual salary
May we contact this employer for a reference check?
Yes No

Please place a check mark in the appropriate box next to each category that you have a MINIMUM of six months experience.

Accounting
Accountant Payables Cost Accounting
Bookkeeper Receivables Taxes
General Ledger Payroll (CPA) Certified Public Accountant
Collections
Clerical
Customer Service Admin Assistant Legal
Data Entry Transcription Mailroom
Reception/Switchboard Medical Shipping/Receiving
Clerk Bi-lingual Spanish
Banking/Financial
Teller Lending Officer Have Certifications
New Accounts Mortgage
Branch Manager Securities/Investments
Human Resources
Compensation/Payroll Hiring/Terminations Safety
Compensation/Benefits Testing Records Management
Employee Relations Training Have Certifications
Insurance
Agent /Broker Bonds Property
Health Casualty Life
Annuities Liability Have Certifications
Light Industrial
 
Driver Shipping/Receiving Installation/Maintenance/Repair
Machine/Press Operator Inventory Control Soldering/Welding
Assembler Warehousing Printing/Bindery
Quality Control Forklift Picker/Packer
Assembly Production Assemble Inventory Taker
Material Handler/Casual Labor Packaging/Warehouse Warehouse/Ship/Receive
Warehouse/Stock Clerk Warehouse/Stock Picking/Packing Restaurant Worker
Maintenance Janitor/Maintenance Housekeeper
Groundkeeping/Landscaper Printing Services Carpenter
Construction Roofing Electrician
Painter/Industrial Spray Factory Painter/Interior/Exterior Bldg Pipe Fitter
Welding/Electric Arc Welding/Gas Metal Arc Mig Welding/Gas Tungsten Arc Tig
Welding/Spot Welder Mechanic/Diesel Mechanic/Repairer/Building Maintenance
Mechanic/Motor Vehicle/Light Truck Mechanic/Small Engine Building/miscellaneous/Blue Prints
Vehicle/Chauffer Vehicle/Driver/Commercial Heavy Equipment Operator
Bulldozer Operator Loader/Tractor Operator Vehicle/Tractor/Semi Trailer
Special License/CDL Machine Operator Break Press Operator
Injection Plastic Molding/Die Casting operator Punch Press/Stamping Operator Sewing Operator
Shrink-Wrap/Hat Sealing Operator Hand Tool Operator Drill Press Operator
Precision Production/Grinding Precision Production/Lathe Precision Production/Sheet Metal Fabricator
Tool & Die Maker
Medical
CNA CPT4 Coding Medical Billing
LPN ICD9 Coding Medical Collections
RN Medical Insurance Transcription
Marketing/Sales
Advertising Route Sales Telemarketing
Public Relations Inside Sales Retail Cashier
Graphic Designer Outside Sales Retail Manager
Technical
Engineering Telecommunications Computer Software
Architecture Computer Programming Computer Networks
CADD Computer Hardware Service Tech
Help Desk
Other
Auto Industry Hospitality Transportation
Government Management Scientific
Military Real Estate Social Services
Bi-lingual Spanish    

I certify that the statements I have made are true and correct and without material omission. I understand that making false statements or omitting pertinent facts is sufficient cause for rejection or dismissal from employment. I authorize obtaining information from any person(s), employers, educational institutions, licensing authorities, and/or law enforcement agencies concerning my background, work habits, skill or conduct on the job, with the exception of past employer(s) I have indicated that are not to be contacted. I hereby release such person or entities from all liability for damages for issuing such information.

I also agree that if I am employed, now or at any time in the future, my employment may be terminated at any time without liability to me for wages or salary except for such wages or salary which I earned prior to the date of my termination. I understand the term of my employment shall be limited to the duration of any assignment that I accept.

I am aware that Public Law 91-508, known as the Fair Credit Reporting Act, requires the employer to inform me that a routine inquiry may be made that will provide applicable information concerning my character, my general reputation, my personal characteristics and my credit history. Upon written request, I will provide additional information as to the nature and scope of the inquiry or any report which is produced.
Please take a moment to review your form.  Indicate that you have read the above statement by entering your initials in the box below.  To complete this form, click on the Submit Form button.
Initials:    


Premier Staffing, Inc. is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with Premier Staffing, Inc. depends solely on your qualifications.


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