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New Level Staffing Application

First name

Last name

Date Of Birth

Phone

Address

How soon can you start?

Are you a citizenof the U.S?

Yes

If No, are you authorized to work in the U.S?

Yes

Have you worked for us before?

Yes

If Yes, when?

Have you worked for a staffing agency before? If yes, please state what agency. If no, please put N/A below.

Have you ever been convicted of a Felony in the U.S?

Are you willing to consent to a background check?

Yes

Please state Name of school you last attended.

Upload File

Work Experience #1

Company

Position

Address

Supervisors Name

Start Date

End Date

Phone

Starting Salary

Responsibilities

Reason For Leaving

Work Experience #2

Company

Position

Address

Supervisors Name

Start Date

End Date

Phone

Starting Salary

Responsibilities

Reason For Leaving

Work Experience #3

Company

Start Date

Position

Address

End Date

Phone

Supervisors Name

Starting Salary

Responsibilities

Reason For Leaving

Are you looking for temporary employment or a career?

Temporary Employment

Career

Why did you leave your previous employer? If terminated, why?

How would your previous supervisor or manager describe your personality and work performance?

How did you occupy your time while you were unemployed?

What are some reasons that will cause you to call out of work or miss your assignment?

Where do you see yourself in five years?

Is there anything that would hold you back from being a consistent and reliable employee?

How do you handle conflict in the workplace?

Confrontational

Avoid and stay to yourself

Talk to a supervisor and/or manager

Try to solve a problem

How is your attendance in the workplace?

Excellent

Good

Fair

Needs Improvement

How are your communication skills in the workplace?

Excellent

Good

Fair

Needs Improvement

How did you hear about New Level Staffing? If referred, list who referred you.

Please list THREE professional references.Note: These contacts WILL be contacted. Please list Name| Position| Company| Phone Number| Email

Please list an Emergency Contact. Include: Name| Relationship| Phone| Email

Consent and Release for Drug Test Pre-Employment : I understand that pursuant to New Level Staffing's Policy for a Drug-Free Workplace, I am being required to a drug screening test. I hereby consent to submit to urinalysis test as shall be determined by New Level Staffing for the purpose of determining the use of illegal drugs. I agree that New Level Staffing, or an alternate company selected facility, may collect these specimens for these test and may test them or forward them to a testing laboratory designated by the Company for analysis. I further agree to and hereby authorize the release of the results of said tests to the Company. I understand that it is the current illegal use of drugs and/or abuse of alcohol that prohibits me from obtaining employment with the Company. I am unaware of any medical condition that would indicate that either the screen or physical examination might endanger my physical health. I agree to hold harmless the Company and its agents from any liability arising in whole or part out of the collections specimens, testing, and use of information from said testing in connection with the Company's consideration of my continuing employment. I agree that a reproduced copy of the this consent and release form shall have the same force and effect as the original. I have carefully read the foregoing and fully understand its consents. I acknowledge that mu signing of this consent and release form is a voluntary act on my part and that I have not been coerced into signing this document by anyone.

Photo Release Consent: I hereby give permission to New Level Staffing to use my photo by signing below. I understand that my image, name, and/or position maybe used for presentational purposes.

Safety Pledge: As an employee of Kruse & Associates it is my responsibility to adhere to all safety guideline of Kruse & Associates, OSHA, and the location I am assigned for work. By signing my name at the end of this pledge I am acknowledging that I have read, understand, and will abide by all the items listed above and below I will practice safety first and foremost in the work that I perform and in the work that is around me I will wear all safety equipment required in the performance of my job at all times, no expectations I will not short cuts in the performance of my job I will perform my job as required by my supervisor or manager, any concerns for safety or compliance will be reported to Kruse & Associates I will not do anything that might endanger myself or another employee If directed, I will wear no jewelry while in the workplace that could possibly result in an injury to myself or another employee I will wear the correct "uniform" in the workplace as directed by my supervisor or manger I will not involve myself in any "horseplay" while on the employer's property or worksite I will use those tools and methods as having been directed by my supervisor or manager that are required in the performance of my job in the most productive and safest manner If I am injured in any manner I will report it to my supervisor or manager immediately, having it documented, and getting medical attention at once. I will also ask that any injury is reported immediately to the Kruse & Associates office staff. If I have been found to have violated any of these safety procedures I may be terminated from my job assignment by Kruse & Associates and the company assigned to and that I may be considered to have self-RESIGNED from my position.

Thank you! We’ll be in touch.