Employment Application Are you at least 18 years of age and do you have the legal right to work in the United States? Yes No Name First Last Nickname / Preferred Name SS Number:(Required) Date Of Birth(Required) MM slash DD slash YYYY Address Street Address/Apartment City State ZIP / Postal Code Home Phone(Required)Other Phone(Required)Email Address(Required) Resume – If you have a plain-text resume, paste it into the box below.Resume UploadMax. file size: 256 MB.AvailabilitySelect the branch you are applying to:Select BranchGoldsboroGreenvilleJacksonvilleNew BernRoanoke RapidsRocky MountTarboroWilsonAre you willing to work temporary? Yes No Are you looking for a full-time career position? Yes No Are you looking for contract positions? Yes No When are you available to start? MM slash DD slash YYYY What weekday hours are you available?First ShiftFirst and Second ShiftAll ShiftsFirst and Third ShiftSecond ShiftThird ShiftIf necessaryNot availableAM onlyPM onlyWhat weekend hours are you available?First ShiftFirst and Second ShiftAll ShiftsFirst and Third ShiftSecond ShiftThird ShiftIf necessaryNot availableAM onlyPM onlyHow many hours are you willing to work in a week?Part Time (0 to 20 hours a week)Full Time (More than 20 hours a week)Are you willing to work overtime? Yes No What is the minimum pay you desire? How much notice will you need if a position is offered to you?One Day1 Week2 Weeks3+ WeeksMore Than One DaySame DayHow many miles are you willing to travel to a position? Education Enter most recent – Do not enter start and end date if the most recent is high school Name of School Type of schoolCommunity CollegeHigh SchoolProfessional SchoolTechnical or Trade SchoolUniversityOtherStreet Address City State / ZIP Code ZIP Code Start Date (Month / Year) MM slash DD slash YYYY End Date (Month / Year) MM slash DD slash YYYY DegreeTrade SchoolCertificationHigh School DiplomaGEDAttended College, No DegreeCollege Coursework in ProgressAssociate DegreeBachelor's DegreeBachelor of ArtsBachelor of ScienceMaster's DegreeMasters of ArtsMaster of Business AdministrationMasters of ScienceDoctorate DegreePhilosophiae DoctorJuris DoctorateMDOtherMajor Study Area Other Studies Recent Employment List most recent firstCompany Name(Required) Address Street Address City State / Province / Region ZIP / Postal Code Supervisor Name Job Title Job DutiesStart Date (Month / Year) MM slash DD slash YYYY End Date (Month / Year) MM slash DD slash YYYY Start Wage Hourly rate or annual salaryEnd Wage Hourly rate or annual salaryMay we contact this employer for a reference check? Yes No Company Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor Name First Last Job Title Initials: Job DutiesStart Date (Month / Year) MM slash DD slash YYYY End Date (Month / Year) MM slash DD slash YYYY Start WageHourly rate or annual salaryEnd WageHourly rate or annual salaryMay we contact this employer for a reference check? Yes No Company Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Supervisor Name First Last Job Title Job DutiesStart Date (Month / Year) MM slash DD slash YYYY End Date (Month / Year) MM slash DD slash YYYY Start WageEnd WageMay we contact this employer for a reference check? Yes No Criminal Background & Drug ScreenHave you been convicted of a crime in the last 7 years, other than a minor traffic violation? If yes, please explain: Yes No Please explainAre you willing to take a drug screening test? Yes No Special Skills and QualificationsINDUSTRIAL SERVICES Assembly Electronic Assembly- Blue Prints Assembly – Soldering Production Assembly Distribution Lamination Inventory Taker OSHA/HAZMAT Team Leader Inventory Ship/Receive Stock Picking/Packing Security Guard Mold Building/Repair Tool Crib Attendant Warehouse Manager Housekeeper Landscaping/Grounds Keeping Lamination Mechanic/Repairer – Motor Vehicle/Light Truck Mechanic/Repairer – Small Engine Electronic Assembly Assembly – Electrical/Wiring Mechanical Assembly Bindery Worker Quality Control Inspector/Tester Boat Manufacturing Material Handler/Casual Labor Quality Control Mgr Packaging/Warehouse Load/Unload Stock Clerk Pallet Jack Order Picker Food Handler/Processor Maintenance Janitor/Maintenance HVAC Printing Services Mechanic/Repairer MACHINE OPERATION CNC EDM Drilling & Boring Lathe Milling Sawing Tool & Die Maker Autobagger Blow-Molding Electroplate Injection Plastic Molding-Die Casting Punch Press/Stamping Shrink-Wrap/Heat Sealing Drill Press Nail Gun Wire Wrapping CNC EDM OPT/Programmer/Setup Grinding Machinist Millwright Sheet Metal Fabricator Sander Metal Bending Brake Press Injected Metal Molding-Die Casting Drill Press Sewing Bandsaw Drill Routers Wood OFFICE / PROFESSIONAL Customer Service Data Entry Secretarial – Legal Stenographer Office Clerk Shipping/Receiving Compensation – Benefits Training Quality Control Banking Computers Scheduling Microsoft Office Legal Graphic Design Outside Sales Route Sales Auto – Title Clerk Secretarial Secretarial – Medical Education Clerks – Inventory Management Policies & Procedures Recruiting Notary Public Loans Quickbooks Microsoft Excel Insurance Paralegal Technical Writer/Editor Retailing Telemarketing ACCOUNTING Certified Public Accountant Accountant Cashier Employee Benefits Inventory Payroll Receivables Invoicing Budgets – Production Bank Statements Cash Accounting Financial Accounting Trusts Staff Accountant Bookkeeper Cash General Ledger Payables Payroll Taxes Credit & Collections Audits Annual Reports Financial Statements Cost Accounting Taxes Purchasing CONSTRUCTION Carpenter Carpenter – Rough in Cabinet Maker Framing Roofing Iron Work Insulation Concrete Site Cleanup Plaster/Dry Wall Electrician – Licensed Extrusion Painter – Industrial Spray Pipe Fitter Tradesmen Helper Tape Measurer Carpenter – Finish Construction Drywall Scaffolding Fiberglass Masonry Flooring Demo Electrician Low Voltage Wiring Installer Painter Painter – Interior/Exterior Building Pipe Fitter – Plumber Blue Prints MINING Off-Road Dump Truck Excavator Motor Grader Plastic Welding Dozer (large) Loader Water Truck Diesel Mechanic PM Mechanic Fuel/Grease General Labor (Mine Industry) Concrete Labor (Mine Industry) MSHA Training OSHA Training VEHICLE & EQUIPMENT OPERATION Forklift Operator Stand Up Reach Forklift Overhead Crane Operator Cherry Picker Clamp Commercial CDL INDUSTRIES Aerospace/Aircraft Electrical Food Mechanical Pulp and Paper Automobile Electronics/Computers Mining Petro Chemical Textiles WELDING Electric Arc Gas Metal Arc Mig Oxy Acetylene Gas Plastic Welding Stick Steel Gas Tungsten Arc Tig Brazing Spot Welder Aluminum LANGUAGES Arabic Dutch German Italian Latin Sign Language Braille English Greek Japanese Polish Spanish Chinese French Irish Korean Russian Vietnamese MEDICAL CMA Billing Medical Records Lab Tech Insurance Applicant Statement(Required) I agree to the statement belowI authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision as in accordance with established company procedure. I authorize the use of any information in this application to verify my statements, and I authorize the past employers, all references, and other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information. I understand that nothing contained in this employment application or in the granting of any interview is intended any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Holden Temporaries, Inc. unless made in writing. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and Holden Temporaries, Inc. retains the same right. I understand that prior to being offered employment with Holden Temporaries, Inc. I may be requested to take an examination. In the event I have a disability which will affect my ability to take the test, I will so inform Holden Temporaries, Inc. prior to the administration of the test so that a reasonable accommodation can be made. Requested accommodations may include accessible testing sites, modified testing conditions, and accessible testing formats. Holden Temporaries, Inc. reserves the right to require medical documentation concerning the need for accommodation. I further understand that if an offer of employment is tentatively made to me, it might be conditioned upon my successful completion of a medical examination. I understand that if employed, policies and rules which are issued are not conditions of employment and that the employer may revise policies or procedure, in whole or in part, at any time. The application for employment shall be considered active for a period of time not to exceed 12 months. If your phone number or address changes during this time, please let us know so that we can still get in touch with you when an opening becomes available. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer, and business I am sent to.
