"The Friendlier Agency"
 
Please completely fill out the form below. *indicates required field
First Name*
Middle Name
Last Name*
Street Address / Apartment*   
City*
State / ZIP Code*  
Main Phone* - Area code and phone number
Other Phone - Area code and phone number
Email Address
Emergency Contact Name*  Phone Number -
Text Resume - If you have a plain-text resume, please paste it in the field below.
Education
Enter the highest level of education completed.
Name of School*
Type of school*
City*  
State/Province*
Country
Completion* (mm/yy)
Degree/Diploma*
Major Study Area
Other Studies

Agreement
Have you ever been convicted of a crime in the past ten years excluding misdemeanors and summary offenses, which have not been annulled, expunged or sealed by a court?*
Yes No
If yes, please fully describe below:
Your initials below authorizes and requests any present or former employer, school, police department, financial institution, division of motor vehicles, or other persons or agencies having personal knowledge about me to furnish bearer with any and all information in their possession regarding me, in connection with an application of employment. I give permission that a photocopy of this authorization be accepted with the same authority as the original.

I agree that the information provided in this application is correct and complete to the best of my knowledge.
Initals
Availability
Are you willing to work temporary?*
Yes No
Are you available for long term assignment?*
Yes No
Do you have use of a car?*
Yes No
Are you a student?*
Yes No
Will you accept same day assignment?*
Yes No
When are you available to start?* (mm/dd/yy)
What days are you available?*
Mon. Yes No
Tues. Yes No
Wed. Yes No
Thurs. Yes No
Fri. Yes No
Sat. Yes No
Sun. Yes No
What hours are you available?*
Week Day Yes No
Week Night Yes No
Grave Yard Yes No
Weekend Day Yes No
Weekend Night Yes No
What geographical locations are you available for?*
North of Downtown Yes No
Downtown Yes No
South of Downtown Yes No
Eastside Yes No
How many hours are you willing to work in a week?*
Are you willing to work overtime?*
Yes No
Professional Experience
List most recent (or present) first.
REFERENCE #1
Company Name*
Street Address*
City*
State / ZIP Code*  
Main Phone* - Area code and phone number
Supervisor Name*
Job Position/Title*  
Job Duties*  
Start Date* (mm/dd/yy)
End Date* (mm/dd/yy)
End Wage* Hourly rate or annual salary
Reason For Leaving*  
May we contact this employer for a reference check?*
Yes No
REFERENCE #2
Company Name*
Street Address*
City*
State / ZIP Code*  
Main Phone* - Area code and phone number
Supervisor Name*
Job Position/Title*  
Job Duties*  
Start Date* (mm/dd/yy)
End Date* (mm/dd/yy)
End Wage* Hourly rate or annual salary
Reason For Leaving*  
May we contact this employer for a reference check?*
Yes No
REFERENCE #3
Company Name
Street Address
City
State / ZIP Code  
Main Phone - Area code and phone number
Supervisor Name
Job Position/Title  
Job Duties  
Start Date (mm/dd/yy)
End Date (mm/dd/yy)
End Wage Hourly rate or annual salary
Reason For Leaving*  
May we contact this employer for a reference check?
Yes No
 
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