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Phone: 228-207-5674

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Please fill out all sections before submitting. Thank You for choosing Empowerment Staffing Solutions, LLC for you employment services.

Full Name

Address

Phone

Available start date

Positions Interested In

How Did You Hear About Us

Days Available

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Which Shift(s) Are You Available

Day

Swing

Grave

If Needed, Are You Willing To Work Overtime?

Yes

Do You Have Reliable Transportation?

Yes

Pay Rate Desired

Have you ever applied to or worked for Empowerment Staffing Solutions, LLC? If Yes, when

Do you know anyone who is currently working for Empowerment Staffing Solutions, LLC? If Yes, please list their name and relationship.

Are you at least 18 years of age or older?

Yes

Are you a U.S citizen or approved to work in the United States?

Yes

What documents can you provide as proof of citizenship or legal status

Will you consent to a mandatory controlled substance test?

Yes

Do you have any condition in which it would require job accommodations? If yes, please describe below.

Have you ever been convicted of a criminal offense (felony or misdemeanor)?

Are you a member of the Military or have served in the Military?

Yes

If yes, Which branch did you enlist?

How many years did you serve?

Job Qualifications

Previous Employer 1

Previous Employer 2

Previous Employer 3

Education

References

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Additional Information

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Today's Date

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