Mailing Address:

City, State, Zip:

Physical Address:

City, State, Zip:

Telephone:            

Message / Cell:

Email:

POSITION INFORMATION:

Position Applying For:

Status:

Full-Time Only Part-Time Only Full and Part Time          Temporary Only Temporary-Hire Only Direct Hire Only All

Minimum Wage Accepted:        Desired Wage:

Cities willing to work in (select all that apply):

*To Select Multiple Cities, press crtl and click on cities*

Salem/Keizer Woodburn McMinnville Silverton Stayton/Sublimity Dallas Grand Rhonde Lincoln City Albany Corvallis Eugene/Springfield  

EDUCATION: (list applicable education first)

College / Trade School:

Program / Area of Study:

Date of Graduation or Expected Graduation:

College / Trade School #2:

Program / Area of Study:

Date of Graduation or Expected Graduation:

SKILLS:                                                                               Indicate whether you possess the skill by marking "yes" if you have experience utilizing the skill, or "no" if you do not have experience utilizing the skill.

Bilingual: No English/Spanish English/Russian English/ASL English/Other

Assembly: Yes No

Cannery: Yes No

Carpentry: No Yes

Drywall: Yes No

Electrician: Yes No

Food Service: Yes No

Inventory: Yes No

Landscaping: Yes No

Painting: Yes No

Production: Yes No

Shipping/Receiving: Yes No

Warehouse: Yes No

Welding: Yes No

PREVIOUS EMPLOYMENT

Are you currently employed? Yes No

List most recent/current first: *do not exclude any employer*

Employer #1:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone Number:

Duties:

Reason for Leaving: (if terminated, list reason given)

Employer # 2:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone:

Duties:

Reason for Leaving: (if terminated, list reason given)

Employer # 3:

Start Date:                            End Date:

Start Wage:                          Ending Wage:

Title:

Phone:

Duties:

Reason for Leaving: (if terminated, list reason given)

Have you been terminated from a job not listed above?

Yes No

Have you left a position without a two-week notice?

Yes No

Have you ever been convicted of a crime (including major traffic) or have a pending case?

Yes No

If so, explain:

CERTIFICATION:

By submitting the application above, you state that all of the above answers are true and accurate to the best of your knowledge. You understand that any false information and/or statements are grounds for immediate termination, in the event employment is offered.

You authorize MVPs to conduct reference checks on your employers, less current employer, stated above. You agree to release Mid-Valley Placement & Staffing, Inc. and any employer acting under this certification from liability.

You understand that MVPs is a employment service. You understand that we will attempt to place you on a job to which you qualify for, however, you further understand, we do not guarantee employment to anyone.

I have read and agree to the above statements. I am signing this electronically by providing my last 4 digits of my SSN.

Last 4 of SSN:

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