Choice One Staffing: Application

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:

Emergency Contact Information

Contact Name:

Contact Phone:

Check if you are legally authorized to work in the United States:

Resume: Your Resume will not be submitted unless you complete all *required fields

Resume File Name:

Position

*What position are you applying for:

Date available for work:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

Minimum rate per hour:

What times are you available to work from:

To:

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:

Are you available direct-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, OR, VT, WA):

Employer Information 1

Name of Employer:

Employment Dates

From:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

To:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

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:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

To:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

Location

Address:

City:

State:

Zip Code:

Job Information

Supervisor Name:

Supervisor Phone:

Job/Position:

Pay Per Hour:

Reason For Leaving:

Employer Information 3

Name of Employer:

Employment Dates

From:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

To:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

Location

Address:

City:

State:

Zip Code:

Job Information

Supervisor Name:

Supervisor Phone:

Job/Position:

Pay Per Hour:

Reason For Leaving:

Employer Information 4

Name of Employer:

Employment Dates

From:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

To:

April 2025

	Sun	Mon	Tue	Wed	Thu	Fri	Sat
14	30	31	1	2	3	4	5
15	6	7	8	9	10	11	12
16	13	14	15	16	17	18	19
17	20	21	22	23	24	25	26
18	27	28	29	30	1	2	3
19	4	5	6	7	8	9	10

Location

Address:

City:

State:

Zip Code:

Job Information

Supervisor Name:

Supervisor Phone:

Job/Position:

Pay Per Hour:

Reason For Leaving:

Temporary Employment

Check if you have ever used a recruiting firm to obtain employment (Temp or Perm):

Agency I

Firm Name:

Address:

City:

State:

Zip Code:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

Agency II

Firm Name:

Address:

City:

State:

Zip Code:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

Education

High School Education

Name of high school:

High school degree:

High school diploma/certificate:

Business or Other Education

Name of school/program:

School/program degree:

School/program diploma/certificate:

College

Name of college:

College degree:

College diploma/certificate:

Apply For The Job

I certify that the information on this application is true and factual

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.