Thank you for taking the first steps to joining our winning team here at INGENIUM RESOURCE STAFFING.


We are thrilled that you have taken the first steps to joining our winning team here at INGENIUM RESOURCE STAFFING. Please take the time to fill out each document completely, as this will ensure that we get all information necessary for you to begin working shifts. In order to complete the online application, we will also need the following information:

A. Copy of Current License
B. Copy of BLS or ACLS
C. Copy of your Diploma
D. Copy of your current TB test or chest X-ray
E. Copy of your current Driver’s License
F. Copy of your Social Security Card

Application for Employment
Personal Information
Name (Last Name, First)
   		Social Security No.
Email Address (required a valid email address)
Present Address
 City, State, Zip Code
Permanent Address
 City, State, Zip Code
Home Phone
 Cell Phone
Referred By:
 Phone No
 
Employment Desired
Position
 Date you can start
Salary Desired
Are you currently Employed
Yes         No
If so, may we inquire of your present employer?
Yes          No
Ever applied to this company before?
Yes          No
Where
 When
 

Education History
Name&Location of School
Grammar School
 Years Attended
Did you graduate
 Subjects Studied
High School
 Years Attended
Did you graduate
 Subjects Studied
College
 Years Attended
Did you graduate
 Subjects Studied
Trade, Bussiness or Correspondence School
 Years Attended
Did you graduate
 Subjects Studied
 

General Information
Subjects of special Study/Research Work or special training/Skils:
Us Military or Naval Service
 Rank
 

Former Employers (List below last three employers, starting with last one first)
Date Month and Year
From
 Date Month and Year
To
Name&Address of Employer
Salary
 Position
Reason For Leaving
   
Date Month and Year
From
 Date Month and Year
To
Name&Address of Employer
Salary
 Position
Reason For Leaving
   
Date Month and Year
From
 Date Month and Year
To
Name&Address of Employer
Salary
 Position
Reason For Leaving
 

References
Name
 Address
Employer
 Years Known
   
Name
 Address
Employer
 Years Known
   
Name
 Address
Employer
 Years Known
   

Emergency Notification

In the event of an EMERGENCY, please notify the person listed below
Emergency Contact Name
 Relationship
Daytime Phone Number
Night
Street Address
City
State
Zip Code
 


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