Personal Information
Salutation:
*First Name:
M.I.:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
Nickname:
Email:
*How did you hear about us?:
*Home Phone:
Cell Phone:
Other Phone:
*What position are you applying for:
Date available for work:
October 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
27
28
29
30
1
2
3
41
4
5
6
7
8
9
10
42
11
12
13
14
15
16
17
43
18
19
20
21
22
23
24
44
25
26
27
28
29
30
31
45
1
2
3
4
5
6
7
Minimum rate per hour:
Emergency Contact Information
Contact Name:
Contact Phone:
Check if you are legally authorized to work in the United States:
Resume Uploaded!
Click Submit To Send Your Resume!
Days you are available for work:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
What shifts you are available to work:
Shift 1:
Shift 2:
Shift 3:
Checking the below boxes indicates YES:
Do you have transportation:
Will you accept a same day assignment:
Will you accept a long term assignment:
Are you available part-time:
Are you available full-time:
Are you available temp-to-hire:
Previous Employment
Enter as much information as you can. More details will help us better serve you. (Salary/Pay per hour: NOT REQUIRED in AL, CA, CO, CT, DC, DE, HI, IL, MA, MD, ME, MN, NJ, NY, OH, OR, VT, WA):
Employer Information 1
Name of Employer:
Employment Dates
From:
October 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
27
28
29
30
1
2
3
41
4
5
6
7
8
9
10
42
11
12
13
14
15
16
17
43
18
19
20
21
22
23
24
44
25
26
27
28
29
30
31
45
1
2
3
4
5
6
7
To:
October 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
27
28
29
30
1
2
3
41
4
5
6
7
8
9
10
42
11
12
13
14
15
16
17
43
18
19
20
21
22
23
24
44
25
26
27
28
29
30
31
45
1
2
3
4
5
6
7
Location
Address:
City:
State:
Zip Code:
Job Information
Supervisor Name:
Supervisor Phone:
Job/Position:
Pay Per Hour:
Reason For Leaving:
Employer Information 2
Name of Employer:
Employment Dates
From:
October 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
27
28
29
30
1
2
3
41
4
5
6
7
8
9
10
42
11
12
13
14
15
16
17
43
18
19
20
21
22
23
24
44
25
26
27
28
29
30
31
45
1
2
3
4
5
6
7
To:
October 2026
Sun
Mon
Tue
Wed
Thu
Fri
Sat
40
27
28
29
30
1
2
3
41
4
5
6
7
8
9
10
42
11
12
13
14
15
16
17
43
18
19
20
21
22
23
24
44
25
26
27
28
29
30
31
45
1
2
3
4
5
6
7
Location
Address:
City:
State:
Zip Code:
Job Information
Supervisor Name:
Supervisor Phone:
Job/Position:
Pay Per Hour:
Reason For Leaving:
Apply For The Job
By checking this box, you declare that all statements contained in this application are true and correct and understand that false or inaccurate information in this application may be the basis for termination. You also agree to receive text messages from Champion Personnel at the phone number provided regarding job offers and employment-related issues. Message frequency varies. Message and data rates may apply. Consent is not a condition of purchase. Reply STOP to unsubscribe or HELP for assistance. View our Privacy Policy (
https://championpersonnel.net/privacy-policy/)
and SMS Terms (
https://championpersonnel.net/sms-terms/)
on our website. ----- Al marcar esta casilla, usted declara que toda la información contenida en esta solicitud es veraz y correcta, y comprende que proporcionar información falsa o inexacta en esta solicitud puede ser motivo de rescisión. Asimismo, acepta recibir mensajes de texto de Champion Personnel en el número de teléfono facilitado en relación con ofertas de trabajo y asuntos laborales. La frecuencia de los mensajes varía. Pueden aplicarse tarifas de mensajería y datos. El consentimiento no es una condición para realizar una compra. Responda STOP para cancelar la suscripción o HELP para obtener ayuda. Consulte nuestra Política de privacidad (
https://championpersonnel.net/privacy-policy/)
y los Términos de SMS (
https://championpersonnel.net/sms-terms/)
en nuestro sitio web.
Please
CLICK
'SUBMIT YOUR APPLICATION'
ONLY ONCE
. Depending on your connection speed it may take a few seconds for your computer to cycle to the next screen. Please be patient, the system is processing the application. If you click this button more than once you run the risk of submitting multiple applications.
Submit Your Application