First Name: * Last Name: * Address Line 1: City: * State: * ZIP Code: Country: Home Phone Number Work Phone Number Can we call you at your current work phone?: ??? No Yes Personal cell Phone Number * Alternate Phone Number E-mail address: * Are you currently employed? * ??? Yes No May we contact your present employer? * ??? No Yes On what date would you be available to work? * Are you able to work * Full Time: ??? No Yes Part Time: ??? No Yes Are you able to work Temporary: ??? No Yes Contract: ??? No Yes Are you currently on "Layoff" status and subject to recall? ??? No Yes Are you currently self employed? ??? Yes No Description of current or past self employment Have been convicted of a felony? ??? Yes No If yes description of felony How long have you lived at your current address?: months How long do you expect to live in your current area?: months Internet speed you currently have at your home? Are you willing and able to work weekends & evenings? ??? Yes No Would this job be your only means of Support? ??? Yes No If no description of other support How many days did you miss work in the last Six Months? How many days did you miss work in the last year? How well do you verbally communicate in English? ??? Not so good OK Good Excellent Have you ever been on call for a client or employer? ??? Yes No How many hours a week can you work? Hours Description of available work schedule
What do you expect as a minimum hourly rate * ($$)
Previous or Current Employer Info: * Employer Name Employer Phone Your Title Reason for Leaving Work performed Final Salary / Hourly Rate * Employment Starting Date (Month/Year 12/99) * Ending:
Previous Employer Info: * Employer Name Employer Phone Your Title Reason for Leaving Work performed Final Salary / Hourly Rate *
Employment Starting Date (Month/Year 12/99) * Ending:
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