Application for Employment

Jacobson Staffing Interview

Would your former employer consider you reliable?
YESNO

Did you have good attendance?
YESNO

Do you have convictions?
YESNO If yes FelonyMisdemeanor

Do you have Experience with:
Heavy EquipmentLoadersDozerExcavatorsCraneOperationWater TruckDump TruckGraderForkliftPallet JackRF ScannerMine Equipment

In other equipment
MSHAOSHA 10OSHA 30CDLOther

Do you have safety equipment?
St BootsHardhatSafety GlassesGloves

Do you have valid DL?
YESNO

Do you have a clean driving record?
YESNO

Can you commute?
YESNO

Days Available?
AnyMTWThFSSun

What shifts are you available for?
AnyDaySwingGraveyard

Are you available for on call?
YESNO

Are you currently signed up with another staffing agency?
YESNO

Will you call us once a week to confirm your availability?
YESNO

Will you notify us if you are no longer looking for work?
YESNO

Application For Employment

Jacobson Staffing Solutions is an Equal Opportunity Employer

Do you have reliable transportation?
YESNO

Do you have a valid Driver's License?
YESNO

Are you looking for more than temporary work?
YESNO

What days are you available?
Full TimePart TimeRotatingWeekends

What shifts are you willing to work?
Day ShiftSwing ShiftGraveyard Shift

If required would you be able to take and pass a drug test?
YESNO

Are you legally eligible to work In the United State ?
YESNO

WORK HISTORY

May we contact?
YESNO


May we contact?
YESNO


May we contact?
YESNO

References -

Give at least three(3), not relatives, who have known you well during the past five(5) years.



Notification and Authorization to Release Criminal Information for Employment Purposes

Notification
The position for which I am being considered require me to consent to a criminal background check as a condition of employment. This check includes the following: Criminal history reference searches for felony and misdemeanor convictions at the country and federal levels of every jurisdiction where I currently reside or where I have resided during the past 7 years: and the sex offender registry searches at the country and federal levels in every jurisdiction where I currently reside or where I have resided.

Authorization
I hereby authorize Jacobson Staffing Corp, to conduct the criminal background check described above. In connection with this, I also authorize the use of law enforcement agencies and/or private background check organizations to assist Jacobson Staffing Corp, in collecting this information Sterling Talent Solutions has been secured as a third party vendor (consumer reporting agency) to assist Jacobson Staffing Corp, in collecting and verifying information.

I am also aware that records of arrests on pending charges and/or conviction are not an absolute bar to employment.

Please Print (for identification purposes):

Full Legal Name:

Gender
FemaleMale