Branch Office Use Only
Ultra-Staff Date:
Entered By:
EMPLOYMENT APPLICATION  
  PERSONAL INFORMATION  
  Please Print/Type the following:  
 
Soc. Sec. #           
Today's Date:
                 
Name:        
  Last   First   MI    
Address        
  Street   City   State                Zip Code
Phone:
       Alt/Message #:            E-Mail:    
 
     
 
EMPLOYMENT DESIRED
Position applying for: Salary desired:
Are you applying for: Regular full time work Part time work Temporary Work
List the days and hours you are available for work:
Are you available for work on weekends? Yes No On-call? Yes No
Would you be available to work overtime, if necessary? Yes No
Have you ever applied to or worked for CornerStone before?: Yes No If yes, when?
List locations(s):
How did you hear about CornerStone? Yellow Pages Job Fair Web Site Flyer Friend Newspaper
College Poster? If so, which college?:
Career Center? If so, which:
If hired, would you have a reliable means of transportation to / from work? Yes No
Are you at least 18 years old? Yes No
(If under 18, hire is subject to verification that you are of minimum legal age or are emancipated.)  
If offered a position, can you present evidence of your U.S. Citizenship or proof of your legal right to live and work in this country? Yes No
Are you able to perform the essential functions of the job for which you are applying? If no, the functions that cannot be performed: Yes No
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.)  
Are you able to perform all other duties of the job for which you are applying? If no, the functions that cannot be performed: Yes No
(Note:Hire may be subject to passing a medical examination, drug screen, criminal and employment background check, credit check, DMV report and social security number verification.)
 
EMPLOYMENT DESIRED - CONT.
Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No
(Convictions for marijuana-related offenses that are more than two years old need not be listed.)  
If yes, state nature of the offence(s), when and where convicted and disposition of the case:  
(Note: No applicant will be denied employment solely on the grounds of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered in acceptance of this application.)
Are you currently employed? Yes No
If so, may we contact your current employer? Yes No
Please list companies you have contacted on your own, or through some other source, so that we will not duplicate your efforts.
1.             2. 
3.    4. 
         
 
 
EDUCATION, TRAINING AND EXPERIENCE
     
 
School Name and Address   No. of years Did you Complete Degree or Graduate? Diploma?
High School      
Yes
No
 
College/ University    
Yes
No
 
Vocational/ Business    
Yes
No
 
 
     
 
Many of our customers (clients) do not speak English. List any other language(s) you speak, write or understand:
 
List any other experience, training, qualifications or skills that you feel make you especially suited for work at CornerStone.
 
EMERGENCY CONTACT #1
Emergency Contact:    
Phone:
           
Address:          
 
No. Street
  City   State                Zip Code
 
EMERGENCY CONTACT #2
Emergency Contact:    
Phone:
           
Address:          
 
No. Street
  City   State                Zip Code
 
PLEASE CHECK EXPERIENCE RELATED CATEGORIES:
Secretary/Admin. Typist Other
Business Machines Word Processing
Computer skills
Executive
Administrative
Medical
Legal
Statistical
Transcription
Clerk/Typist
Filing
Accounting
A/P A/R
Paytroll/10-key
  By Touch
Typing Speed Wpm
Data Entry Spm
Switchboard
Phone Lines
 
# of Lines
   
Word Processing Exp: Yes No
  MSWord MSExcel MSOutlook
  Windows (OS) Macintosh (OS)    
 
Other:
 
Industrial General Labor Manufacturing General Assembly
Shipping Receiving
Inventory
Stocking
Forklift Certified
Pallet Jack
Other:
Mechanical Assembly
Electro/mechanical
Wafer
PCB
Inspection
Other:
Surface Mount Assembly
Packaging Machine Operator
Machine Feeder
Machine Operator
Metal Product Assembler
Plastic Product Assembler
 
EMPLOYMENT HISTORY/ WORK REFERENCES
List below all present and past employment history/work references starting with your most recent employer (last 10 years is sufficient). Account for all periods of unemployment. You must complete this section even if submitting a resume.
     
 
Name of Employer:                           
Address:       
 
No. Street
  City   State                Zip Code
Type of Business:            
Telephone No.:
Supervisor's name:
Duties:
Position held:
Date of employment -- From: To:
Weekly Pay -- Starting: Ending:
Reason for leaving:            
 
     
 
     
 
Name of Employer:                           
Address:       
 
No. Street
  City   State                Zip Code
Type of Business:            
Telephone No.:
Supervisor's name:
Duties:
Position held:
Date of employment -- From: To:
Weekly Pay -- Starting: Ending:
Reason for leaving:            
 
     
 
     
 
Name of Employer:                           
Address:       
 
No. Street
  City   State                Zip Code
Type of Business:            
Telephone No.:
Supervisor's name:
Duties:
Position held:
Date of employment -- From: To:
Weekly Pay -- Starting: Ending:
Reason for leaving:            
 
     
 
     
 
Name of Employer:                           
Address:       
 
No. Street
  City   State                Zip Code
Type of Business:            
Telephone No.:
Supervisor's name:
Duties:
Position held:
Date of employment -- From: To:
Weekly Pay -- Starting: Ending:
Reason for leaving:            
 
     
Upload Resume
 
Please Read Carefully, Choose a Branch, and Authorize Below
 
I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
 
I hereby authorize the company to thoroughly investigate my references, work record, education, criminal background, motor vehicle records, credit history, social security number, and conduct a drug screen test, and other matters related to my suitability for employment. I authorize the references I have listed to disclose to CornerStone Staffing Solutions, Inc. any and all letters, reports, records and other information related to my work records, without giving me prior notice of such disclosures. In addition, I hereby release CornerStone Staffing Solutions, Inc., my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
 
I understand that nothing contained in the application, conveyed during any interview or during my employment, if hired, is intended to create an employment contract between me and ornerStone Staffing Solutions, Inc. In addition, I understand and agree that if I am employed; my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or CornerStone Staffing Solutions, Inc. No promises or representations contrary to the foregoing are binding on CornerStone Staffing Solutions, Inc. unless made in writing and signed by me and a CornerStone Staffing
Solutions, Inc. designated representative.
 
  Select Branch:  
  (your application will be sent
directly to the selected
Cornerstone Staffing office)