Please provide the following information (*notes a required field):

First Name*:  

Middle Initial:

Last Name*:  

Street Address*:  

Address (cont.):

City*:  

State*: IL AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY  

ZipCode*:    

Home Phone*:    

Social Security Nbr*:    

E-mail*:    

How did you learn about us*? Advertisement Employment Agency Friend Relative Skills Match Walk-In Other  

On what date would you be available to work*?    

Are you available to work:      Full-Time Part-Time 1st Shift 2nd Shift 3rd Shift

If you are under 18 years of age, can you provide proof of your eligibility to work?      N/A Yes No

Have you ever filed an application with an SC2 Inc. staffing agency?      Yes No      If yes choose agency Century Illini Midstate Mustang Schmitt Tri-County

Have you ever been employed with an SC2 Inc. staffing agency?      Yes No      If yes choose agency Century Illini Midstate Mustang Schmitt Tri-County

Are you currently employed?      Yes No

May we contact your current employer?      Yes No

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?      Yes No

     (Proof of citizenship or immigration status will be required upon employment.)

Are you currently on "lay-off" status and subject to recall?       Yes No

Can you travel if a job requires it?      Yes No

Have you been convicted of a felony within the last 7 years?      Yes No
(Conviction will not necessarily disqualify an applicant from employment. Applicant is not obligated to disclose expunged juvenile records of arrest or conviction.)

If yes please explain:

Do you have a high school diploma or equivalent?      Yes No

Indicate any foreign languages you can speak, read and/or write.

If you are a current XPAC or recently laid off XPAC employee, please check this box.           

Please check all that apply to your prior experience:

      Forktruck operator
      Office
      CDL A
      PC
      CDL B
      Microsoft Office
      CDL C
      Mechanic
      Spotter/Jockey Driver
      Maintenance
      Powder Coat Paint
      Welding

Describe any job-related training:

Employment Experience

Although there are many aspects of the application, interview, and other criteria considered when determining an applicant's placement in the applicant pool, work history is an important part of this process when determining placement.

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer:

Address:

Phone Number(s):

Job Title:

Supervisor:

Start Date:  

End Date:  

Starting hrly rate/salary:

Ending hrly rate/salary:

Worked performed:

Reason for leaving:

Employer:

Address:

Phone Number(s):

Job Title:

Supervisor:

Start Date:  

End Date:  

Starting hrly rate/salary:

Ending hrly rate/salary:

Worked performed:

Reason for leaving:

Employer:

Address:

Phone Number(s):

Job Title:

Supervisor:

Start Date:  

End Date:  

Starting hrly rate/salary:

Ending hrly rate/salary:

Worked performed:

Reason for leaving:

Employer:

Address:

Phone Number(s):

Job Title:

Supervisor:

Start Date:  

End Date:  

Starting hrly rate/salary:

Ending hrly rate/salary:

Worked performed:

Reason for leaving:

Additional Information

State any additional information you feel may be helpful to us in considering your application.

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer.

I accept the above applicant's statement:                  Yes  

WE ARE AN EQUAL OPPORTUNITY EMPLOYER