Name First Middle Initial Last Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Alt. Phone #Phone #1. What position are you applying for? Do you have a resume?YesNo2. Have you ever applied with Expert Staffing before?YesNoWhat office? Date MM slash DD slash YYYY 3. How did you hear about Expert Staffing? 4. Are you 18 years or older?YesNo5. Do you have reliable transportation to work every day?YesNo6. Some of our positions require repetitive lifting of up to 50 lbs. Is this something you are capable of doing?YesNoUnsure7. Do you have proper identification that proves you are eligible to work in the United States?YesNo8. Are you willing to take a drug screen according to our policy?YesNo9. Have you ever worked for any other Staffing Agencies?YesNoWhat company were you placed at? Previous EmploymentFrom MM slash DD slash YYYY To MM slash DD slash YYYY Name of Employer Position Reason for Leaving From MM slash DD slash YYYY To MM slash DD slash YYYY Name of Employer Position Reason for Leaving From MM slash DD slash YYYY To MM slash DD slash YYYY Name of Employer Position Reason for Leaving From MM slash DD slash YYYY To MM slash DD slash YYYY Name of Employer Position Reason for Leaving I hereby declare that all statements contained in this pre-application are true and correct.Applicant Reset signature Signature locked. Reset to sign again Date MM slash DD slash YYYY Δ