associate's I-9 Form to confirm work authorization. ... Position. TO. Reason For
Leaving. Duties. Performed. Supervisor's. Name ... Anyone not giving a 24-hour
notice upon resigning and or walking off their position will be considered as a.
APPLICATION FOR EMPLOYMENT
Quality Personnel
Quality Personnel is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, national origin, the presence of mental, physical, or sensory disability, sexual orientation, or any other basis prohibited by Federal, state or local law. PERSONAL INFORMATION (Please Print)
Date Applying (M/D/Y) __________________
Last Name: ______________________ First Name: ____________________ Middle Name: _________________ Current Address: ___________________________________________________________________________________________ Street City State Zip Code Telephone Number: ______________________________ Email Address: ________________________________ Emergency Contact Name: ____________________________ Telephone Number: ________________________ Are you less than 18 years of age? Yes ___ No ___ Have you been convicted of a felony? Yes ___ No ___ If yes, list convictions that are a matter of public record (arrests are not convictions). A conviction will not necessarily disqualify you for employment. Factors related to your conviction will be taken into consideration. __________________________________________ __________________________________________
Are you legally eligible for employment in the U.S.? Yes ___ No ___ Quality Personnel participates in the E-Verify Program. If you are hired, you will be required to provide proof of identity and legal authority to work in the United States and to complete an I-9 Form. Quality Personnel will provide the Social Security Administration (SSA) and the Department of Homeland Security (DHS), with information from each new associate’s I-9 Form to confirm work authorization.
EMPLOYMENT DESIRED Position: ____________________________________ Location: _______________________________________ Salary Desired: __________ Date you can start: _____________ Are you able to work overtime? Yes ___ No ___ Specify hours you are available for each day of the week
EDUCATION
Sunday
Monday
School Name & Address
Tuesday
Wednesday
Thursday
Years Completed
Did you graduate?
High School
1 2 3 4
Y N
College
1 2 3 4
Y N
Other
1 2 3 4
Y N
Friday
Saturday
Subject Studied / Degrees Received
FORMER EMPLOYEES List below current and last two employers, starting with most recent one first. Please include any nonpaid/volunteer experience, which is related to the job for which you are applying. Please complete even if you attach a resume. Current Employer (Name and Address of Employer - Type of Business)
FROM
Pay Rate?
Position Reason For Leaving
TO Duties Performed Supervisor's Name
Phone Number
May We Contact?
Current Employer (Name and Address of Employer - Type of Business)
FROM
Pay Rate?
Position Reason For Leaving
TO Duties Performed Supervisor's Name
Phone Number
May We Contact?
Current Employer (Name and Address of Employer - Type of Business)
FROM
Pay Rate?
Position Reason For Leaving
TO Duties Performed Supervisor's Name
Phone Number
May We Contact?
REFERENCES Provide below the names of three professional references, whom you have known at least one year. Name
Address & Phone Number
Business
How do you know this person?
1 2 3
APPLICANT STATEMENT. I certify that all information I have provided in order to apply for and secure work with Quality
Personnel is true, complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from Quality Personnel service, whenever it is discovered. I expressly authorize, without reservation, Quality Personnel, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume or job interview. I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and federal immigration laws require me to complete an I-9 Form in this regard. I also understand that Quality Personnel will provide the Social Security Administration (SSA) and the Department of Homeland Security (DHS), with information from each new associate’s I-9 Form to confirm work authorization. I understand that any employment offered is for an indefinite duration and is “at will” and that either I or the Quality Personnel may terminate my employment at any time with or without notice or cause.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT: I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement. Signature of Applicant: ______________________________________ Date: ________________
Employment Policy Acknowledgement Quality Personnel requires that you read, comprehend and initial each policy section to verify your understanding of our company policy. Please read each policy section and initial each indicating that you have read and understand. 1. Quality Personnel is your employer, NOT the company to which you are assigned. If there are any questions or concerns on the job, please contact us. (_____ initial) 2. Quality Personnel office hours are Monday through Friday 8:00 am to 5:00 pm. It is your responsibility to notify us if you are going to be late for work or absent, before you are to be at the assignment and not after. We have a call forwarding 24 hours a day for such calls. (_____ initial) 3. Quality Personnel hires employees for a variety of assignments of different lengths. Before accepting any assignment, check your calendar for prior commitments. Our clients expect workers to complete each assignment whether short or long term. Often employees do not consider temporary work important and do not feel it necessary to give notice to the company at which they are working or to Quality Personnel when they quit. Therefore, Quality Personnel requires a mandatory 24-hour notice for anyone resigning assignment for anything other than a pre-approved medical or family emergency. Anyone not giving a 24-hour notice upon resigning and or walking off their position will be considered as a company violation and voluntary quit. (_____ initial) 4. Once you complete an assignment with a client, it is MANDATORY to report back to Quality Personnel the same day that your assignment ends and thereafter each day, as required by company policy. This is a requirement for every employee. Failure to report daily for reassignment or to accept a new job assignment offered without reaso nable cause will indicate that you have refused available work. That means that you voluntarily quit Quality Personnel and your file will be deactivated. (_____ initial) 5. Quality Personnel DOES NOT guarantee you a minimum of hours per shift or assignment. At times, your shift may be very short or possibly canceled for the day due to production runs or company slowdowns. (_____ initial) 6. Our order of assignments is: 1. employees with repeat jobs, 2. employees requested back by a client, 3. employees with the most skills, experience and reliable transportation, 4. employees who called in on a daily basis. (_____ initial) 7. If you DO NOT complete the full shift, walk off or abandon any work assignment without notice, means you have quit. Unacceptable reasons could result in termination. If you think the job you have been assigned is unsafe, call the office. DO NOT walk off the job. If your ride leaves the job site, notify Quality Personnel and stay on the job until your work is completed. Quality Personnel will arrange for your return to the office. (_____ initial) 8. If you get lost going to a job site, do not drive back home or to Quality Personnel office. Instead, call the office immediately for directions and get to the job site as quickly as possible. (_____ initial) 9. The clients of Quality Personnel require clean, well-groomed employees with a neat, professional appearance and a good job performance. Office employees must dress professionally. Industrial employees are required to wear long pants and work shoes or boots (sandals, open toes shoes, sleeveless shirts or halter tops are not permitted). Many industrial jobs will require safety equipment. Failure to comply will result in you being turned down for assignments or in termination if you are abusively non-compliant. (_____ initial) 10. Quality Personnel or clients may provide necessary safety equipment. You will be required to wear it as required by our clients. If equipment is lost or damaged, you will be expected to pay for its replacement. (_____ initial) 11. Quality Personnel clients pay for and expect a good day’s work from each employee assigned to their job site. You are to arrive 10 minutes early for work and work hard doing what is expected from your supervisor. Breaks, lunches and other privileges are at the discretion of your supervisor and only when approved. Most of the clients you will be working for have a policy stating that there is NO Smoking allowed in the building or on the site. You must adhere to the smoking policy as explained by your job site supervisor. Failure to do what is expected at the client job site will result in a client asking for you NOT to RETURN. No warning will be given. Termination will be immediate in the case of theft, smoking in non-designated areas, willful or careless damage of property, and/or physical, verbal or harassing attacks directed toward any Quality Personnel or client employees. (_____ initial) 12. Quality Personnel has a very strict substance abuse policy. Drug or alcohol use while on the job will result in imme diate termination. Our client companies may request random drug testing. In case of a work related injury, you will be required to submit to a drug test. (_____ initial)
13. Quality Personnel will not tolerate the carrying or use of firearms or any instrument that may be considered a weapon on our premises or that of our customers. Quality Personnel and its clients observe the right to call the police on the job site and that will be considering trespassing. (_____ initial) 14. If you
are injured on the job you are required to: report the injury immediately to the client company and Quality Personnel if medical treatment is required, report for care at the Quality Personnel company approved physician submit a drug test follow the medical advise and treatment of the Quality Personnel company approved physician be available for any shift for light duty work as authorized by the Quality Personnel approved physician
If you do not follow these rules regarding job injuries, Quality Personnel may not be held liable for any expenses you incur. Any act of horseplay on an assignment is considered grounds for termination. If you are requested to perform any duties other than those given to you by Quality Personnel, please notify us immediately. (_____ initial) 15. I agree to all Quality Personnel hire policies as follows: Temp to Hire means if I am introduced to a company that chooses to hire me permanently, I will work temporary for the required number of hours while being paid by Quality Personnel. I agree not to go to work for any company to whom I have been introduced to by means of temporary assignment or interview except through Quality Personnel, for a period of 90 days after my last date of employment or introduction to that company. Our Temp to Hire policy is 480 hour and per our client’s discretion. (_____ initial) 16. The base wage at Quality Personnel is minimum wage. The hourly wages earned beyond the base vary from job to job and depend upon your skills training and experience. All wage information is confidential and is to be discussed only with Quality Personnel office representatives.(_____ initial) 17. In order to get paid, you must submit your timecard and with your hours worked and client’s signature on it. Quality Personnel will not accept any timecard that has been altered to any degree until it is verified by the supervisor. Any forgery of a time card resulting on a non-billing of a customer will result in prosecution. Any addition of time to a time card without client approval and resulting on a non-billing will be reason for prosecution. Any time card brought in that is incorrect could cost you a one-day delay in getting your pay check. (_____ initial) 18. I authorize Quality Personnel to payroll deduct from my earnings the following deductions: (i) replacement of company property that I damaged or lost, (ii) to reimburse the company for documented overpayments, (iii) for standard company bank/payroll processing fees to receive a replacement for lost or stolen check (iiii) Any shirts / accessories issued to you, (iiiii) Drug test fees, background fees etc . (_____ initial) 19. You must provide Quality Personnel with a written, signed and dated authorization giving permission for someone other than yourself to physically pick-up your payroll check. If you choose to have your check mailed, we cannot be responsible for the stop payment necessary to re-issue a replacement check should it become lost in the mail. Any bank charge at that time will be your responsibility. (_____ initial)
I have read the Employment Policy Acknowledgement and the importance of each one.
_____________________________________________________________________________________________________
Name
Sign
Date
RELEASE STATEMENT I hereby grant Quality Personnel and its authorized representatives at any time during my application for employment, or during the course of my employment, authority to conduct an inquiry into my employment history and performance. I understand that as part of this inquiry a criminal record, driving record and credit check may be conducted. I release from liability all persons, companies, schools and corporations supplying such information and hold harmless Quality Personnel and its representatives from any and all liability resulting from the background inquiry. ____________________________________________ Applicant Signature
________________________________ Date
____________________________________________ Name (Please Print)
Applicant: Please complete the following for proper identification purposes. ___________________________________________________________________________________________ Last Name First Name Middle Name ___________________________________________________________________________________________ Street City State Zip Code ___________________________________________________________________________________________ Social Security Number Date of Birth ___________________________________________________________________________________________ Drivers License or Identification Card Number State Issued ___________________________________________________________________________________________ List any other names or Social Security Numbers you have used ___________________________________________________________________________________________ List any felony charges or felony convictions and provide the date(s), county/parish and state
Each applicant with Quality Personnel is required to read and sign the information below as a condition of employment. SAFETY AND DRUG POLICY Quality Personnel is committed to creating the safest possible work environment for all of its employees and customers. In order to achieve this, all present and prospective employees must adhere to our safety policies as a term of employment. Refusal will result in discharge. The majority of accidents in the workplace are caused by unsafe acts. By using good judgment, following procedures and keeping the work site drug and alcohol free, this number can be greatly reduced. To ensure that drugs and alcohol do not enter or affect the workplace, Quality Personnel may take any or all of the following steps during work hours:
Observe actions of employees Counsel employees Chemical screening (urinalysis, blood test, etc)
Quality Personnel will implement “for-cause” chemical screening. “For-cause” testing will be required in the event of irrational or unusual behavior, injury, accident or damage to client personnel or equipment. Disregard for the safety and well being of company employees or customers will not be tolerated. Employees who refuse to allow a chemical screening or attempt to invalidate the test will be terminated. This form shall also serve as consent for release of medical information and emergency notification in the event of an accident or injury. The undersigned further states that he or she has read the foregoing form and knows the contents thereof and signs the same of his or her free will. ____________________________________________ Applicant Signature
________________________________ Date
____________________________________________ Name (Please Print) BACKGROUND CHECK / DRUG TEST RELEASE I understand by signing this form I am acknowledging that before I am placed on any assignment, I am willing to take and pass a drug test and background check. I agree to have the results released to the client to whom I am assigned, should they request them ____________________________________________ Applicant Signature ____________________________________________ Name (Please Print)
________________________________ Date
EMPLOYEE HANDBOOK ACKNOWLEDGMENT My signature acknowledges that I have read the Quality Personnel Employee Handbook, Employment Policy Acknowledgement in the application packet including Quality Personnel harassment policy and complaint procedure. I understand that I am expected to adhere to the policies set forth in this Handbook. I understand, however, that the policies in this Handbook are not terms or conditions of employment, that these policies may be changed unilaterally by the Company from time to time, and that there may be other things expected of me that are not reflected in the Handbook. I also understand that nothing in this Handbook creates an express or implied contract of employment and that my employment is “at will” and may be terminated, either by myself or by the Company, at any time. EMPLOYEE SIGNATURE: __________________________________ EMPLOYEE NAME (print): __________________________________ DATE: _______________________________________
