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:
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Position
*What position are you applying for:
Date available for work:
January 2025
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Minimum rate per hour:
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:
Preferred Shift:
Shift 1:
Shift 2:
Shift 3:
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:
Cities Will Work:
Cities:
Skills
Skills:
TRANSPORTATION TO WORK? : Car/Drive
TRANSPORTATION TO WORK? : License
TRANSPORTATION TO WORK? : Bus
TRANSPORTATION TO WORK? : Ride
TRANSPORTATION TO WORK? : Bike
FACTORY : Assembly
FACTORY : Production Line
FACTORY : Quality Inspection
FACTORY : Packer
FACTORY : Injection Mold Op
FACTORY : Assembly w/hand tool
FACTORY : Trimming
FACTORY : Picker
FACTORY : Machine Operator
FACTORY : Electronic Assembly
WAREHOUSE : Shipping
WAREHOUSE : Receiving
WAREHOUSE : Computer Skills
WAREHOUSE : Inventory
WAREHOUSE : Order Selector
WAREHOUSE : Load/Unload
EQUIPMENT : Power Tools
EQUIPMENT : Hand Tools
EQUIPMENT : Pallet Jack
EQUIPMENT : Forklift
EQUIPMENT : Type
EQUIPMENT : Steel Toe Boots
EQUIPMENT : RF Scanner
EQUIPMENT : Saws
SKILLED : Welder
SKILLED : Machinist
SKILLED : CNC Operator
SKILLED : Micrometers
SKILLED : Calipers
SKILLED : HVAC
SKILLED : Carpenter
SKILLED : Electrician
SKILLED : Mechanic
SKILLED : Construction
LIFTING/ OTHER : 0-20 lbs
LIFTING/ OTHER : 20-40 lbs
LIFTING/ OTHER : 40 + lbs
LIFTING/ OTHER : Janitorial
LIFTING/ OTHER : Landscaping
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:
January 2025
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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:
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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:
January 2025
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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:
January 2025
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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 hereby authorize BarryStaff Inc. and all former employers, and others given by me as reference, to answer all questions and to give all information in connection with this application or in any way concerning me, and it is understood and agreed that any misrepresentation (including omission of information) by me in this application will result in cancellation of the application and/or immediate termination of employment with BarryStaff Inc. I agree, if employed by BarryStaff Inc., that if ever I make claims against you for personal injuries, upon your request I shall submit to drug screens and examinations by physicians of your selection. Your employment of me may be terminated by BarryStaff Inc. at any time without any liability to me except for wages and salary as have been earned by me at the date of such termination. I understand that it is my responsibility to notify you of my availability on a weekly basis at a minimum, and if I do not, I will be considered unavailable for work.
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