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TEMPORARY and PERMANENT STAFFING
If you wish to direct this correspondence to a specific individual, indicate here:  

If you are not sure who to send your resume to, click on Submit Resume at the end of the form. The staffing specialist handling your area of expertise will contact you directly if any additional information is needed.

Applicant Profile Form

* - required field
Personal
* First Name
Middle Intial
* Last Name
* Address
* City
* State/Province
* Zip
* Home Phone
  Work Phone
  Cell Phone
Home E-mail
Work E-mail
Someone, other than your spouse, who can always contact you if you relocate.
Name
Phone
Employment
* Name of employer * Present Last
  Position title
  Product or Service
  Division of
  Are there any companies
we should not contact
when finding you a position?
* Currently Employed? Yes No
* If no, last day worked? / /
  Will consider Permanent
Contract/Temp-to-Hire
Part Time
  Will you work shifts? Yes No
  If yes, what shifts? All 1st 2nd 3rd
  Why are you available?
  Date available / /
Position Desired
* #1
#2
* What factors do you desire in a new position?
Comments
Please list anything else you feel would contribute to a successful placement, i.e. special skills, training or experience, personal situations, etc.
Salary
    (select appropiate category)
    Per Annum Per Hour
* Current or last salary/wage earned $, $.
  Additional Bonus/Commission $, NA
* Desired salary $, $.
* Minimum acceptable $, $.
Education
* Do you have a College Degree? Yes No
  If yes, please fill in your information below:
* Degree #1
* Major/Discipline
  Other:
* GPA
 
  Degree #2
  Major/Discipline
  Other:
GPA
 
  Degree #3
  Major/Discipline
  Other:
GPA
Licenses/Certifications
Special Qualifications
* Do you have the legal right to work in the United States without sponsorship? Yes No
Optional: U.S. citizen  Permanent resident  Canadian citizen
Other    Visa type if other
  Other than English, list any languages you speak
* Have you ever been convicted of a felony? Yes No
  If yes, please explain
Relocation
* Interested in relocation? Yes   No
  If yes, you must complete the following section:
 
Northeast Southeast Midwest Western
All
None
Indicate below: 		All
None
Indicate below:		 All
None
Indicate below:		 All
None
Indicate below:
Use Ctrl+click to select multiple states
Preferred Relocation
Will not relocate to
Responsibility for Personal Information

Your initials certify that you have provided here and in your resume complete and accurate information with no pertinent or otherwise important information omitted. They will also authorize Pedersen, Kolb & Assoc., Inc. or Flexible Staffing, Inc. to investigate and verify all statements in this application, to secure any necessary information from your employers, references, academic institutions and to share your resume and other pertinent information with our client companies or other affiliated search firms working on your behalf.

Your initials also hereby release all of those employers, references, and academic institutions, and Pedersen, Kolb & Assoc. and Flexible Staffing, Inc., from any and all liability arising from their giving or receiving information about your employment history, your academic credentials or qualifications, and your suitability for employment.
* Initials  Date: 2/8/2012
Resume
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