Trac Software - Powered by Embrace Technologies

EOE STATEMENT

We are an Equal Opportunity Employer. We will consider applicants for this position without regard to any category protected by applicable federal, state, or local law, including but not limited to: race, color, religion, sex, national origin, age, physical or mental disability, genetic information, veteran status or uniformed service-member status.

If hired, I understand my employment is at-will as permitted under applicable state law. I understand this means that either the company or I may terminate the employment relationship at any time, for any reason, with or without notice or cause.

1/12

PERSONAL INFORMATION

First Name: * Required

Middle Name: * Required

Last Name: * Required

Date of Birth: *

Open the calendar popup.

Required

ADDRESS

Address: * Required

Address 2:

Address 3:

City: * Required

State: *

-- Select A State --

Required

Zip: * Required

PHONE & EMAIL

You must enter at least one phone number...

Home:

Cell:

Other:

Email: * Required

EMPLOYMENT HISTORY

If so, please explain:

The next 3 forms will allow you to give us information on your last 3 employers.

EMPLOYER 1

Current / Most Recent Employer Name:

Address:

Phone #:

Immediate Supervisor (Name / Position):

Job Title / Responsibilities:

Start Date:

End Date:

Open the calendar popup.

Start Rate (Hr):	Final Rate (Hr):

Reason for leaving:

EMPLOYER 2

Employer Name:

Address:

Phone #:

Immediate Supervisor (Name / Position):

Job Title / Responsibilities:

Start Date:

End Date:

Open the calendar popup.

Start Rate (Hr):	Final Rate (Hr):

Reason for leaving:

EMPLOYER 3

Employer Name:

Address:

Phone #:

Immediate Supervisor (Name / Position):

Job Title / Responsibilities:

Start Date:

End Date:

Open the calendar popup.

Start Rate (Hr):	Final Rate (Hr):

Reason for leaving:

EDUCATION

Select the Last Grade Completed:

9th

Name and Location of School(s) Above:

Please list Degrees, Trade Schools, Skills, Or Special Training that would help us in considering your application:

REFERENCES

REFERENCE 1

Name:

Relationship:

Phone #:

REFERENCE 2

Name:

Relationship:

Phone #:

REFERENCE 3

Name:

Relationship:

Phone #:

MILITARY EXPERIENCE

If you have served in the Military, please answer the following questions.

Select the branch in which you served:

-- Select A Military Branch --

Rank at discharge:

Highest rank attained:

Years in service:

Spin Up Spin Down

Additional Information

CORE QUESTIONS

Position Desired:

-- Select A Position --

If so, please explain:

Why do you feel you are qualified for this position:

How many miles from home are you willing to travel?

Spin Up Spin Down

How many days are you willing to stay away from home:

UP TO 1 MONTH

List any certifications you currently have:

List any past managerial experience:

List any merchandising companies you have worked for:

List any retailers you have worked for:

List any other experiences that may qualify you for this job:

List the name(s) of travel partner(s):

Specifically, how did you find out about Premier Workforce:

Additional Information:

PLEASE READ THE FOLLOWING TERMS CAREFULLY BEFORE SIGNING

PREMIER WORKFORCE INC retains the right to verify all information provided by me. In the process of such verification, I fully authorize PREMIER WORKFORCE INC to contact any school, person, organization, or employer listed to disclose all information necessary to verify information or statements. I release all persons who disclose such information from any liability or damages to me or anyone acting in my name. I waive any written notice of the release of such information that may be required by any state or federal law. Any falsification, misrepresentation, or omission, whenever discovered, shall be considered legitimate and sufficient grounds for dismissal. If hired, I understand that my employment with PREMIER WORKFORCE INC is at-will, as permitted under applicable state law, and furthermore understand this to mean that either the company or I may terminate the employment relationship at any time, for any reason, with or without notice or cause.

Electronic Signature
*(PLEASE TYPE YOUR FULL NAME)*

Required

I understand that the above electronic signature is legally binding and when I press the 'Next' on this form, I am confirming that I acknowledge and agree to the terms above. Furthermore, I certify that all answers and statements on this application are true and complete to the best of my knowledge.