Angela Staffing & Associates LLC

First Name

Last Name

Date of Birth

Address :

Street Address

Apartment / Unit#

State

City

Zip Code

Phone Number

Email Address

Date Available

Social Security No

Position Applied For

Desired Salary($)

Are you a Citizen Of the United States?

YesNo

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

YesNo

Have you ever worked for this company?

YesNo

If yes when?

Have you ever been convicted of a felony?

YesNo

If yes, explain

Highest Level of Education School

Grade

References

Please list one professional references

Full Name

Relationship

Company

Phone Number

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment; I understand that false or misleading information in my application or interview may result in my release.

Certifico que mis respuestas son verdaderas y complete a lo de mi conocimiento. Si esta solicitud conduce a un empleo; Entiendo que la informaci贸n falsa o enga帽osa en mi solicitud o entrevista puede resultar en mi liberaci贸n.

Signature

Date

Emergency Contact Form

Employee Name

Address

Phone Number

Special Instructions

In the event of a medical emergency, are there any emergency procedures or restrictions on medications of which emergency personnel should be aware? If yes, please explain

Emergency Contacts

Primary Contact in case of emergency :

Name

Relationship

Address

Phone Number

Alternate Number

Secondary Contact in Case of Emergency :

Name

Relationship

Address

Phone Number

Alternate Number

Medical Contact

Name of doctor

Address

Phone Number

Employee Authorization

I have voluntary provided the above contact information and authorize ANGELA STAFFING & ASSOC and its representatives to contact any of the above individuals on my behalf in the event of an emergency.

Employee Signature

Date

Work Policies

Name of Employee

All personnel of our agency are obligated to abide with our polices, the supervisor of the company will support and enforce, any employee who does not follow or obey the policies and will be terminated immediately.

It is completely prohibited the use of cellular devices, or any electronic device during the hours of work.
The consumption of drugs and alcohol are prohibited or smoking inside the company during the hours of work.
All workers must be willing to a search of packages, purses, or backpacks without prior notice.
Every personnel should use steal toe shoes when required, tennis shoes, no opened toed shoes, and must walk cautiously
Never abandon your designated job without notice to a supervisor of our agency.
Any incident within the company should get reported immediately to the supervisor of the company that you are working for, no less than 24 hours, or any situation resulting in a said incident is your responsibility
We are not responsible for object or items of value that are lost during hours of work, please leave those valuables at home.
No type of verbal or physical assault will be tolerated between the employees or with supervisors.
Disclosing your arrangements with the agency to others will result in immediate termination.
Any benefits that the agency offers for qualify employees, will be considered after 4 months of consecutive employment as (Health care and Sick day).

Employee Signature

Date

Temporary Staffing Jobs

All the personnel that work for our ANGELA STAFFING & ASSOC agency have knowledge of the type of work that is going to be carried out and the risks or dangers that may occur while carrying out that work.

By signing this document, I am certifying that ANGELA STAFFING & ASSOC has explained to me the type of work I am going to do, the risks and dangers of the job.

and that the safety regulations were given to me and I understand that I must follow these for my safety and protection.

Name

Date of birth

Signature

Date

Criminal History

Consent to background check form for criminal history. Verify authorization waiver itemization. It is voluntary for each employee to be evaluated they must sign an authorization exemption compensation form giving approval to ANGELA STAFFING & ASSOC. to carry out a verification of criminal records.

I hereby give my permission to ANGELA STAFFING & ASSOC to obtain information related to my criminal background history. The criminal history, as received from reporting agencies, may include all arrests, convictions, as well as guilty pleas and deferred adjudications and offending conduct committed with a minor. I understand that this information will be used, in part to determine my eligibility for an employment/ volunteer position at this organization. The background check can be repeated at any time. I understand that I will have the opportunity to review the criminal records received by ANGELA STAFFING & ASSOC and if there is a procedure available to clarify if I dispute the record as I received it. I also understand that the criminal record may contain information allegedly deleted. I hereby affirm that my answer to the above questions is true and correct and that I have not knowingly concealed any facts or circumstances that if disclosed would adversely affect my application. I understand that any false information presented in this application may result in my discharge. I the undersigned do by myself executors and administrators hereby forever release and agree to indemnify ANGELA STAFFING & ASSOC and each one of its officers, directors, employees and agents and I exonerate them from and against each and every one of the actions, lawsuits, responsibility, costs, debts and sums of money, claims and lawsuits of any kind. (including claims for gross negligence and strict liability of ANGELA STAFFING & ASSOC)

Name of Employee

Signature

Date

Gender

MaleFemale

Date of birth

Social Security Number

Address History

Current Address :

Years	State	City	Street	Zip Code

Direct Deposit Form

PLEASE COMPLETE FORM BELOW

Name

Address

Name of Bank

Account Number

Routing Number

Type of Account

CheckingSavings

ANGELA STAFFING & ASSOC you are authorized to deposit my paycheck directly to the mentioned account. This authorized will remain in effect until

[name of employee] modify it to cancel it in writing.

Employee Signature

Date

Declination of Direct Deposit

I [Name of employee] choose to decline the direct deposit option described above. I agree that as of this decline a check in my name will be issued until I modify or cancel this decline in writing.

Employee Signature

Date

Employment Application

APPLICANT INFORMATION

Address :

References

Employment History

Disclaimer and Signature

Emergency Contact Form

Special Instructions

Emergency Contacts

Primary Contact in case of emergency :

Secondary Contact in Case of Emergency :

Medical Contact

Employee Authorization

Work Policies

Temporary Staffing Jobs

Criminal History

Address History

Current Address :

Direct Deposit Form

Declination of Direct Deposit

Useful Links

Recent Search Keywords

Employment Application

APPLICANT INFORMATION

Address :

References

Employment History

Disclaimer and Signature

Emergency Contact Form

Special Instructions

Emergency Contacts

Primary Contact in case of emergency :

Secondary Contact in Case of Emergency :

Medical Contact

Employee Authorization

Work Policies

Temporary Staffing Jobs

Criminal History

Address History

Current Address :

Direct Deposit Form

Declination of Direct Deposit