Personal Information
Emergency Contact Information
*Days you are available for work (min 1):
*What shifts you are available to work (min 1):
*What Preferred Shift you are available to work (min 1):
*General Availability, Checking the below boxes indicates YES (min 1):
*Cities Will Work (min 1):
*Skills (min 1):
Additional Receptionist Skills
Incoming Lines
Previous Employment
Employer Information 1
Employment Dates
Job Information
Employer Information 2
Employment Dates
Job Information
Employer Information 3
Employment Dates
Job Information
Employer Information 4
Employment Dates
Job Information
Temporary Employment
Agency I
Agency II
High School Education
Business or Other Education
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I authorize you and all former employers, given by me as references, to answer all questions and to give all information in connection with this application or in any way concerning me. I authorize FJC and/or its agents to make an independent search of my background, references, character, past employment, consumer reports, education, DMV driving reports and criminal history record information which may be in any state or local files, including those maintained by both public and private organizations, and all public records, for the purpose of confirming the information contained on my application and/or obtaining other information which may be material to my qualifications for employment. A telephone facsimile (fax) or xerographic copy of this consent shall be considered as valid as the original consent. I agree to reimburse FJC for any report which contains information I have failed to disclose that results in my non-employment. The Federal Trade Commission provides a summary statement of your rights on its website at . FJC also provides a copy for you to read in our office.

I agree, if employed by you, that if I ever make claims against you for personal injuries, upon your request I shall submit to examinations by physicians of your selection or mine. My employment may be terminated by you at any time without liability to me except for wages as have been earned by me as of the day of such termination. I understand that if accepted for employment, I will be working for you on your payroll, at your clients’ premises. I understand that any information I learn while working for a client is to be kept confidential. It is agreed that I will obtain your permission before discussing permanent employment with your client.

I state that the information provided you on the application is true and complete. I understand that it shall be grounds for immediate dismissal if any of the information contained herein is found to be untrue. I will hold you harmless from any claims including, but not limited to, personal injury or illness, as a result of my providing false or misleading information on this application.


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