Employment Application

Please complete the application below, then hit submit. Someone from AIM Staffing will contact you. Please complete all fields that are required (*).

First Name*

Middle Name

Last Name*

Maiden Name

Present Address*

City*

State*

Zip*

How long at current address?*

Social Security Number*

Home Phone

Cell Phone*

Email Address*

Age (If under 18)

Position Applied For*

Step 2 of 9

Days/hours available to work:

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

How many hours can you work weekly?* (Numbers Only)

Can you work nights?*

Employment Desired?*

When are you available for work?* (mm/dd/yyyy)

Step 3 of 9

High School

Name of School*

Location (Address)

Years Completed

Graduation*

College

Name of School

Location (Address)

Years Completed

Major and/or Degree

Bus. or Trade School

Name of School

Location (Address)

Years Completed

Major and/or Degree

Professional School

Name of School

Location (Address)

Years Completed

Major and/or Degree

Step 4 of 9

Have you ever been convicted of a crime other than a minor traffic violation?*

If yes, please explain the nature of the offense leading to conviction and final disposition

Do you have a drivers license?*

Means of transportation to work*

Drivers License Number

Drivers License State

License Type

Expiration

Had accidents in last 3 years?*

If so, how many?

Had moving violations in last 3 years?*

If so, how many?

Step 6 of 9

Work Experience

Please list your work experience for the past 5 years beginning with your most recent job held. If you were self-employed, give firm name.

Name of Employer

Address

City

State

Zip

Phone Number (###) ###-####

Last Job Title

Last Supervisor Name

Employment From

Employed Until

Reason For Leaving

Name of Employer

Address

City

State

Zip

Phone Number (###) ###-####

Last Job Title

Last Supervisor Name

Employment From

Employed Until

Reason For Leaving

Name of Employer

Address

City

State

Zip

Phone Number (###) ###-####

Last Job Title

Last Supervisor Name

Employment From

Employed Until

Reason For Leaving

Step 7 of 9

PLEASE READ CAREFULLY

APPLICATION FORM WAIVER

In exchange for the consideration of my job application by AIM Staffing, LLC. I understand that the acceptance of this application does not imply employment and that this application and/or any other documents, do not serve to create an actual or implied contract of employment. I also understand and agree that if employed, the employment will be "at will". That is either I or AIM Staffing, LLC. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that AIM Staffing, LLC. may unilaterally change or revise their policies and procedures at any time.

AIM Staffing, LLC. I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give AIM Staffing, LLC . permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release AIM Staffing, LLC. from any liability as a result of such contract.

I certify that my answers are true and complete to the best of my knowledge.

Signature of applicant*

Date* mm/dd/yyyy

AIM Staffing, LLC. is an equal opportunity employer. We adhere to a policy of making employment decisions without to race, color, religion, sex, sexual orientation, national origin, citizenship, age, or disability. We assure you that your opportunity for employment with AIM Staffing, LLC. depends solely on your qualifications.

Step 8 of 9

AIM Staffing Assignment Requirements

Employees who do not complete there assignment within the first 30 days will be dropped to the minimum hourly pay of $7.25. This includes No Call No shows, walking off the job or any reason that does not meet with completing the assignment.

Indicate any instances or reason you would need to be off within 60 days please list the time and reason below.

You are required to commit and agree to consent to a background screening and reimbursement of $25.00 if you quit any assignment for any reason with in the first 30 Days of accepting an assignment.

You are consenting to a drug screen for pre-employment and if you quit your assignment for any reason within 30 days of accepting the assignment you agree to a reimbursement of $25.00 for in house drug screens and $50.00 for drug screens performed at Concentra, which will be taken out of your last paycheck.

I hereby authorize AIM Staffing LLC. to deduct $15.00 from my paycheck for each uniform t-shirt based on the clients requirements.

Steel toed shoes are required with certain assignments with AIM Staffing LLC. They should be purchased before reporting to work and worn at ALL TIMES when on the work site.

Mandatory overtime is a condition of employment with AIM Staffing, LLC. Some clients (employers) require overtime as a condition for permanent employment consideration.

Date*

Name*

Signature*

(678) 407-2300