Employment Application StaffNet Inc.

Personal Information

Last Name / First Name / Middle / Previous Name (if any)
Street Address
* The Age Discrimination Act prohibits discrimination against anyone over the age of 40.
City / State / Zip / Date of Birth*
Residence Telephone Number / Business Telephone Number / Cell Phone Number
Desired Salary / Email Address
Smoker? Yes No
Unacceptable Geographic Locations:
How did you hear about us?

Education

High School/City/State / Graduated? / Trade/Technical School / Graduated?
College/University / From / To / GPA / Degree
PROFESSIONAL CERTIFICATIONS/Organizations/honors:

Skills

Software Proficiency – Word Processing, Spreadsheets, Presentation Software (i.e. PowerPoint), Graphics, PDA’s (i.e. Blackberry, Palm Pilot), Database Management, HTML (i.e. Front Page), Calendar Management, OTHER. Please rate yourself on a scale of 1-10 (10 as highest) your skill level on these items.
Program / Proficiency Level / Program / Proficiency Level
Typing - WPM / Dictaphone / Shorthand or Speedwriting WPM / Legal, i.e., litigation, corporate

Skills – Accounting – If Applicable

Function / Yes No / Software / Function / Yes No / Software
Full Charge / Payroll
Accounts Receivable / Taxes (list)
Accounts Payable / Budgeting
Bank Reconciliation / Financial Statements
General Ledger / Other
Trial Balance / Other

Have you been through a Conversion? Yes No

Current Licensed CPA? Accounting Software:

Employment Application {continued} StaffNet

Employment Information for ______(please print name)

Month / Year / Base Pay
Employer / Telephone Number / Start / Bonus? / Yes No
End / Bonus Amount
Street Address / Responsibilities
City / State / Zip
Supervisor Name / Supervisor Title
Reason for Leaving
Special Accomplishments
Current (most recent) salary/benefits package information
Benefit / Yes No / Amount / Benefit / Yes No / Amount / Other Benefits
401K Match / Cost of Insurance / N/A
Pension / Paid Parking
Profit Sharing / Car Allowance
Annual Vacation / Flex Hours
Overtime
Month / Year / Base Pay
Employer / Telephone Number / Start / Bonus? / Yes No
End / Bonus Amount
Street Address / Responsibilities
City / State / Zip
Supervisor Name / Supervisor Title
Reason for Leaving
Special Accomplishments
Month / Year / Base Pay
Employer / Telephone Number / Start / Bonus? / Yes No
End / Bonus Amount
Street Address / Responsibilities
City / State / Zip
Supervisor Name / Supervisor Title
Reason for Leaving
Special Accomplishments

Profile - your “elevator speech” – a 2-sentence synopsis of what makes you a great employee:

Recruiter Notes/location preferences:

StaffNet

12600 Deerfield Parkway, Suite 100

Alpharetta, Georgia 30004

678-947-9294 or 404-843-9342

Confidentiality Agreement

Please do not be misled by another recruiting service asking where you may have interviewed so “their efforts are not duplicated”. Unfortunately, many of these firms will call the companies where you have interviewed and try to produce additional candidates for the position. This greatly reduces your chances in getting an offer, and makes our clients unhappy receiving unsolicited telephone calls. Therefore, we request that you not discuss any positions we present to you with any other recruiting firms.

Authorization to Check References

It is our policy to check references regarding past employment and education (your current employer WILL NOT be contacted without your consent). Please indicate your acceptance of this policy by reading the following paragraph, and then signing where indicated.

In consideration of the efforts made by StaffNet Inc. on my behalf, I hereby authorize StaffNet to obtain a reference on my background from any past employer, academic or financial institution. I hereby authorize my former employers and educators to release any information regarding my employment history and/or educational information. I understand that I am entitled to know the nature and scope of such information should I request it. I authorize StaffNet to release such information obtained as a result of this reference checking process to any prospective employer deemed appropriate by StaffNet, and I understand that such information may be conveyed in the form of a paraphrase of the discussion between StaffNet and the reference source. Finally, I hereby release StaffNet, its employees, clients and sources of and from any and all liability and claims arising out of or related to these references and reports, and the acquisition, communication, discussion, rendering or use of said references or reports.

Applicant Name (Typed) / Signature / Date

Please be aware most of our clients require background checks using your social security number for criminal convictions information, and may also require drug testing. If you prefer not to be submitted to those clients, please initial below. By NOT initialing, you authorize StaffNet Inc. to conduct the investigative process.