Skyline MI

APPLICANT INFORMATION

Last Name

First

M.I.

Street Address

Apartment/Unit#

City

State

Zip

Home Phone

Cell Phone

E-mail Address

Are you leagally eligible for employement in the United States?

YES NO

Well you work overtime if asked?

YES NO

Do you have a valid drivers license?

YES NO

If so, what is your license number?

Referred By

EMPLOYMENT DESIRED

Position

Date you can start

Salary Desired

Have you ever worked for this company?

YES NO

If so, when?

Have you ever been convicted of a felony or
been placed on probation?

YES NO

If yes, explain

EDUCATION

High School

Address

From

Did you graduate?

YES NO

College

Address

From

Did you graduate?

YES NO

Degree

Other

Address

From

Did you graduate?

YES NO

Degree

PREVIOUS EMPLOYMENT (BEGIN WITH MOST RECENT)

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Reason for Leaving

May we contact your previous supervisor for a reference?

YES NO

EMERGENCY CONTACT INFORMATION

Name

Relationship

Phone #

Doctor to Notify

Phone #

Any medical considerations, allergies, etc.

AUTHORIZATION AND CONSENT

I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be a basis for termination. I hereby authorize TempCor to investigate my background and references, including a copy of this application to third party sources for the sole purpose of my placement on assignment. I understand that employment by TempCor is at will and that if employed, my employment will not be for any fixed period of time and may be terminated by TempCor at any time with or without cause. I also agree that I may be expected to work on a wide variety of job assignments in the area and agree to accept assignments for which I am qualified as they become available. I also understand my failure to report to any such assignment for work will indicate that I have quit. I also agree to submit to drug screens upon request or as specified in TempCor on their client's substance abuse policies.