Application

This application will be current for a period of 90 days from today.

First and Last Name:Date you are available to begin work:
Current Address: Previous Address:
City, State, Zip: Previous City, State, Zip:
How long at your current address?: How long at your previous address?:
Home Phone: Message Phone:
Are you legally eligible to work in the United States?:
E-Mail: Do you have your own transportation to work?
Have you ever worked for a temporary service? Are you at least 18 years old?
Have you ever worked for and/or applied for work with Jerman Personnel Services, Inc. before? If yes, when?
Do you have any relatives who are employed by Jerman Personnel Services, Inc?
If yes, please list their name(s) and their relationship(s) to you:
How did you hear about Jerman Personnel? (choose one)
Pay rate or salary desired: Position(s) applied for:
Should this position not be available and you would like to be considered for other assignments, the following information is requested to assist us in determining the type of assignments in which you would be interested.
(A) Would you be willing to:Relocate? Travel?
(B) Would you accept:Night Work? 2nd Shift? [select 2nd include_blank "Yes" "No"] 3rd Shift?
Weekend work? Full time work?
Part time work? Temporary work?
Assignments in a smoke-free environment?
(C) If there are days of the week, hours of the day or months of the year when you would generally NOT be available for work, list them:
(D) If there are any work environments and/or job duties for which you do not wish to be considered, please list these work environments and/or job duties:
EDUCATION AND/OR TRAINING
Name of School and Its LocationCourse of StudyGPA (optional)Did you graduate?Type of Degree or Diploma Received
EMPLOYMENT EXPERIENCE
Company Name: Dates Employed: From To
Salary: Beginning Final Reason for Leaving:
Position(s) Held: Major Job Duties:
Company Name: Dates Employed: From To
Salary: Beginning Final Reason for Leaving:
Position(s) Held: Major Job Duties:
Company Name: Dates Employed: From To
Salary: Beginning Final Reason for Leaving:
Position(s) Held: Major Job Duties:
Military Service:Branch of Service Final Rank:
Dates of Active Duty: From To: Specialty(ies):
If any listed dates of employment (including military service, if any) are not consecutive, list reason(s) for the time gaps between jobs:
Have you ever been discharged or asked to resign from any employer? If yes, provide specific explanation:
Have you ever been convicted of ANY crime other than minor traffic violations? If yes, list conviction(s), date(s) and disposition(s) here:
Indicate any areas you have experience with:
 

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