Job Application Job Application Form "*" indicates required fields Step 1 of 7 14% Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Personal InformationName* First Last Address* Street Address / Apt # City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone Number*Email* Emergency Contact* Emergency Phone Number* Employment NeedsHow much advance notice?* Are you willing to work overtime?* Position* Desired Wage* Date You Can Start*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Position Type* PT FT Shifts you are available to work* Day Swing Graveyard Days you are available to work* Monday Tuesday Wednesday Thursday Friday Saturday Sunday Transportation* Private Public Other Bi-Lingual* Yes No Languages Spoken* How far can you travel for position?* How did you hear about Infinity Staffing?* Have you worked for Infinity Staffing?* Work HistoryPLEASE BEGIN WITH MOST RECENT EMPLOYERPosition Employer May We Contact? Yes No PhoneReason for Leaving Supervisor Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Start Date Month Day Year End Date Month Day Year NEXTPosition Employer May We Contact? Yes No PhoneReason for Leaving Supervisor Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Start Date Month Day Year End Date Month Day Year NEXTPosition Employer May We Contact? Yes No Phone Number Reason for Leaving Supervisor Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Start Date Month Day Year End Date Month Day Year EligibilityAre you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No If no, describe ReferencesName Title/Company Realationship PhoneNEXTName Title/Company Realationship PhoneNEXTName Title/Company Realationship Phone EducationHigh School Years Completed Did You Graduate? Yes No Degree or Diploma Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code NEXTCollege/University Years Completed Did You Graduate? Yes No Degree or Diploma Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands NEXTOther Year Completed Did You Graduate? Yes No Degree or Diploma Address Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code SkillsOffice Skills Filing Inventory Accounting Bookkeeper Assistant Payroll Accounts Payable Accounts Receivable Credit/Collections Bank Teller 10-Key Secretarial Skills Executive Adminstrative PC MAC Handheld Scanner Copier/Printer Office Equipment Multi-Line Phone Facsimile Typing Word Processor 10 Key Computer Software Windows MAC Microsoft Word Microsoft Excel Microsoft Powerpoint Microsoft Outlook Quickbooks Quicken Peachtree Construction Woodframe Brick Layer Carpentry Electrical Form Setting Masonry Heavy Operator Forklift Operator Warehouse Loading Driver CDL Class "A" Class "B" Class "C" Service Mechanics Auto Detailing Auto Body Repair Factory Inspection Plating/Anodizing Production/Fabrication Welding Retail Cashier Pricing/Tagging Phone Sales Counter Clerk Shipping/Receiving Medical Nurse CNA Medical Receptionist Medical Records Medical billing Housekeeping Hotel Hospital Laundry Room Maintenance Front Desk Housekeeping Production Packaging Quality Control Labeling Miscellaneous Dispatcher Server Bartender Other Add RemoveOther Add RemoveOther Add Remove Infinity Staffing is an equal opportunity employerEmployment Application CertificationI hereby affirm that the information provided in this application, and any attached or submitted resume, is true and complete and that I have withheld no information that would, if disclosed, affect this application unfavorably. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in dismissal if discovered at a later date. Initial*Completion of this application does not assure me a position with Infinity Staffing Services Inc. I also understand that neither this application nor any other document constitutes a contract of employment for a specific term and that any employment relationship that may be established will be "at will" and may be terminated at any time with or without cause by myself or Infinity Staffing Services Inc. I also understand that no representative of Infinity Staffing Services Inc. has any authority to enter into any agreement for employment with me contrary to the foregoing. Initial*I hereby authorize Infinity Staffing Services Inc. to investigate all information pertinent to my application, including contacting current and former employers in order to determine my qualifications for employment. I hereby authorize all persons and organizations having information relevant to my application to provide said information to Infinity Staffing Services Inc. and I hereby agree to hold harmless Infinity Staffing Services Inc. and all those providing information to it from any liability arising from or as a result of the request for, the provision of or use of such information. I understand that any offer of employment may be rescinded or my employment may be terminated if my references are inadequate or unacceptable to Infinity Staffing Services Inc. or if I violate any of the provisions of this certification. Initial*I further understand that if hired by Infinity Staffing Services Inc., I must abide by all the company rules and regulations as communicated by Infinity Staffing Services Inc. employees and orientation materials which, with the exception of the "at will" employment policy, may be changed without notice at the discretion of Infinity Staffing Services Inc. I understand that (1) Infinity Staffing Services Inc. may require me to submit a drug and alcohol test prior to employment and a drug and alcohol test at any time during my employment, to the extent permitted by applicable law; and (2) Infinity Staffing Services Inc. may require me to consent to or authorize the disclosure of my criminal record and/ or consumer credit report prior to employment and at any time during my employment, to the extent permitted by law. Initial*I certify under penalty of perjury that all the information provided is true and correct to the best of my knowledge and that I have read, fully understood and agreed with the above statements. Signature*Date* Month Day Year PhoneThis field is for validation purposes and should be left unchanged.
