Step 1 of 4 25% Name* First Last Primary Phone*Secondary PhoneE-mail* Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Select Your ASI Office*Which ASI office would you like to register with?---Select One---Boise/Meridian/Nampa OfficeFruitland-Ontario OfficeElko-Winnemucca OfficeTwin Falls OfficeIdaho Falls OfficeBurley OfficePocatello OfficeAre you 18 years of age or older?*YesNoDo you have a valid Drivers License?*YesNoDo you have reliable Transportation?*YesNoWhat type of work are you looking for?* Clerical Labor Is there a specific company you are interested in working for?YesNoDesired hourly wage?*Are you willing to take a drug test according to our policy?*YesNoWill you release your background information inclusive of criminal records?*YesNoPerson to contact in case of emergency* First Last Relation?Emergency contact phone*Have you worked for American Staffing Inc. before?*YesNoIf so... When? Where? Position?When can you work?* Select All Year Around Seasonal Weekends Holidays Days Nights What hours of the day are you available?Position DesiredIf hired when can you start?*Would you travel for work?YesNoIf so where?Have you been convicted of a Misdemeanor in your lifetime?*YesNoOffense(s)*Date of Offense(s)*State of Offense(s)*Have you been convicted of a Felony in your lifetime?*YesNoOffense(s)*Date of Offense(s)*State of Offense(s)*How did you hear about us?* Phone Directory Friend Craigslist Job Board/Website Indeed Newspaper AD Facebook Client Referral Colleague American Staffing Representative Flyer Google/Web Search Other Employment HistoryPlease start with your most recent employer.How many jobs have you held in the last 5 years?*01234+Employer*PhoneJob Title*Pay Rate (per hour or per year)Immediate Supervisor and Title*Reason for leaving*Start Date* Date Format: MM slash DD slash YYYY Are you still employed?*YesNoEnd Date Date Format: MM slash DD slash YYYY May we contact for reference?*YesNoLaterSummarize job duties. Be DESCRIPTIVE*Enter previous position.Employer*PhoneJob Title*Pay Rate (per hour or per year)Immediate Supervisor and Title*Reason for leaving*Start Date* Date Format: MM slash DD slash YYYY Are you still employed?*YesNoEnd Date Date Format: MM slash DD slash YYYY May we contact for reference?*YesNoLaterSummarize job duties. Be DESCRIPTIVE*Enter previous position.Employer*PhoneJob Title*Pay Rate (per hour or per year)Immediate Supervisor and Title*Reason for leaving*Start Date* Date Format: MM slash DD slash YYYY Are you still employed?*YesNoEnd Date Date Format: MM slash DD slash YYYY May we contact for reference?*YesNoLaterSummarize job duties. Be DESCRIPTIVE*Enter previous position.Employer*PhoneJob Title*Pay Rate (per hour or per year)Immediate Supervisor and Title*Reason for leaving*Start Date* Date Format: MM slash DD slash YYYY Are you still employed?*YesNoEnd Date Date Format: MM slash DD slash YYYY May we contact for reference?*YesNoLaterSummarize job duties. Be DESCRIPTIVE* Labor Skills ListingPlease mark all skills you have experience in: Professionally or Personally. Assembly Line Electronics Inspection Manufacturing Semiconductor Computer Assembly Industrial Sewing Industrial Fabric Cutting Auto ASE Certified Body Repair/Painting Detailing Glazier/Glass Installation Tire Tech Service Writer Sales Wheels/Tires Casino Keno Runner Slot Changer Slot Repair Construction Administration Air Guns/Compressor Cabinetry Concrete Dry Wall Fencing Finishing Framing Granite Jack Hammer General Carpentry Masonry OSHA 10/30 Pipe Fitting Plumbing Retaining Walls Roofing Insulation Stucco Trimming/Molding Read Tape Measure Read Blue Prints Drilling Blast Hole Core Helper Powder Crew Reverse Sampler Water Electrical Commercial Residential General Helper Soldering/Wiring Equipment Backhoe Blade Crane (Large) Crane (Small) Crusher Dozer Farm - Baler Farm - Combine Farm - Digger Farm - Digger Rider Farm - Disc Farm - Piler Farm - Tractor Forklift - Diesel Forklift - Electric Forklift - Gas Forklift - Propane Fueler Grader Grade Setter/Blade Hand Haul Truck Loader Mucker Oiler Scrapper Skidder Dump Truck Water Truck Food Processing Fresh Pack Inspection/Q.A. Peeling Quick Freeze Sorting Trimming Line Work Food Service Baker Bar Tender Busing Tables Butcher Short Order Cook Waiter/Waitress Dishwasher Food Service Manager Fast Food Land Environmental Controls Farming Farm Labor - Pruning Farm Labor - Vine Tying Farm Labor - Tree Planting Florist Forest Management Forest Reseeding Gardening General Landscaping Grounds Keeper Nursery Ranching Sprinklers Lumber Wild Life Management Cutting Grading Processing Sorting Mechanic Plant Maintenance Diesel Gas Line Mechanic Small Engine Oiler Mechanic's Helper Heavy Equipment Mechanic Off Road Mining NV Gold BTOC Leach Pad Attendant Leach Pad Liner Leach Pad Welder Surface Underground Drafting Geologist Geo Tech Haulage Hole Watch/Fire Watch Industrial Hygienist Supervisor Lab Sampler Lab Tech Warehouse NV Gold Sites Mill Mill Maintenance MSHA Process Ops Confined Space Hazard Training Radio Tech Surveyor Core Handler Core Sampler Safety Coordinator Security Water Sampling Tech Miscellaneous Air Conditioning Repair Building Maintenance Certified HVAC Delivery Driver (No CDL) Driver (with CDL Dry Cleaners Fiber Glass Fin Clipping Fire Fighting Graphic Design/Art Grind Wheel Guard/Watchman Janitorial Machinist Motel Housekeeping Mover Nuclear Density Certification Pipe Straightener Photography Quality Control Sheet Metal Stables (Horses) Stock Yard (Cattle) Tools (Power Hand) Painting Commercial - Residential Commercial - Other Industrial Non-Commercial Printing Binding Collating Press Operator Typesetting Roadwork Flagger General Surveying Warehouse Bagger Computerized General Inventory/Auditing Material Handling Purchasing Receiving Shipping Palletizer Welding Arc Fabrication Torch Mig Shield Tig Certified Welder Helper Other (please list any labor skills not listed above)Clerical Skills ListingPlease mark all skills you have experience in: Professionally or Personally. Accounting Clerk Controller General Bookkeeping Invoicing Payables Chart of Accounts Receivables Tax Preparation Sales Tax Use Tax Fuel Tax Computer General Knowledge Macintosh PC (or clone) Programming System Administration Insurance Adjuster Claims Underwriter Language Chinese English French German Italian Japanese Korean Russian Spanish Miscellaneous Cashier Stock Clerk Drafting Motel Clerk/Auditor Proof Reading Management Writer - Technical Writer - General Office Data Entry Filing General Office Office Manager Office Machines Phone/Message Taking Purchase Orders Secretary - Executive Secretary - Legal Secretary - Medical Receptionist Transcription Transcription - Legal Transcription - Medical Ten-Key Typing Typing - Legal Typing - Medical Typing - Statistical Payroll Payroll Clerk Fed. Withholding State Withholding Worker's Compensation Union Payroll Sales Auto Over Counter Outside Phone Real Estate Retail Wholesale Software Quick Books Peach Tree AutoCad Databases Live/Link Markview Microsoft Office Microsoft Excel Microsoft Windows Microsoft Word Oracle WordPress Other Accounting Package Terminology Dental Legal Medical Optometry Other (please list any clerical skills not listed above) Certifications and Degrees (please check all that apply)Certifications CDL CNA CNE CPA CPR Cosmetology Dental Hygiene Electrical EMT HVAC Law (License to practice) Mechanic ASE MSHA Paralegal Physical Therapy LPN Plumbing RN Secretarial Teaching - Primary Teaching - Secondary Welding Forklift Other (write any certifications not listed above)Degrees GRE Associates BA. BS. MA. MS. MD. JD. PhD. Other (write any degrees not listed above)Have you been trained in a trade?YesNoIf so, what?EducationGrade, and High School/GEDName of Last School*LocationDid you graduate?YesNoHighest Year Completed1234567891011Date Left (if you did not graduate) Date Format: MM slash DD slash YYYY Please select one*GEDDiplomaDate Received Date Format: MM slash DD slash YYYY If in progress, expected completion date Date Format: MM slash DD slash YYYY College or UniversityInstitution NameLocationYears Attended123456DegreeDate graduated Date Format: MM slash DD slash YYYY Major SubjectG.P.A.Other (Graduate, Trade, etc.)NameLocationLength of CourseWas course completed?YesNoWhen? Date Format: MM slash DD slash YYYY Major SubjectG.P.A.Upload ResumeBefore Signing - Please read carefully!!*I certify that the information in this application is correct to the best of my knowledge and I grant permission to American Staffing, Inc. to verify such information and to conduct such investigation as it deems necessary relevant to this application. Any false statement or misrepresentation on this application shall be sufficient cause for rejection of this application or for dismissal from employment. I also authorize previous employers to release American Staffing, Inc. such information as is relevant to my application for employment. I understand that any offer of employment may be subject to satisfactory completion of a medical examination including a drug screening test. In addition, during employment I may be subject to drug testing and failure to take or pass such a test will be grounds for termination. I further understand and agree that my employment with American Staffing, Inc. is at will and may be terminated by me or American Staffing, Inc. at any time and for any reason. I further understand and agree that the term of my employment with American Staffing, Inc. shall be limited to the duration of any temporary assignment hereunder. I certify that I am not applying for work with American Staffing, Inc. in order to secure regular employment, or further temporary employment, with an American Staffing, Inc. customer. I authorize American Staffing, Inc. to deduct any charges from my paycheck which may be incurred by me, such as uniforms, tools, drug tests, and background checks.NameThis field is for validation purposes and should be left unchanged.