* Last Name
* First Name
* Social Security (last 4 digits) #
* Address 1
* Home Phone
* Cell Phone
* Emergency Phone
Driver’s License / State Id #
Method of transportation:
* Position Desired
* Location Desired
* Salary Desired
* Were you previously employed by us?
If yes, when?
Have you been convicted of a major crime (felony) in the past 10 years? *
(Do not answer “YES” if the
conviction has been pardoned, annulled, expunged, sealed or impounded by a
If yes, please give the
conviction date and nature of the offense.
Nature of conviction
A conviction record will not
necessarily bar employment.
Are you legally eligible for employment in the USA? *
If hired, you are required
to submit proof of your eligibility to work in the USA
Are you over the age of
If no, hire is subject to verification
that you are of minimum legal age.
Do you have any physical,
mental or medical impairments or disability that would limit your job
Have you ever had major
surgery or have you ever suffered a Worker’s compensation injury which would
interfere with your ability to perform the position for which you are
If yes, explain injury
* Name & Address of School
# of Years *
Degree / Major *
Reason Not Completed
It is important that we know your entire work history and dates of employment so we can more easily match you with the best job!
If you only have had a few jobs please place N/A in remainder of boxes
Name & Address
* Type of Business
* Describe the work you did?
* Reason Left
I affirm that the facts set
forth in my application are true and complete and that any false statements are
grounds for dismissal if I am offered employment. I give permission for BP
Staffing to verify my employment references. I understand that if I am offered
temporary employment, I will be working for BP Staffing on its payroll at its
clients’ offices. The only deductions from my salary will be those required by
law to be deducted by employers. I agree to notify BP Staffing either by mail
or telephone within 48 hours of termination of each job assignment. If I fail
to give such notice, BP Staffing may assume that I am not available for
By selecting Send below you certify that you are the applicatant and agree with the above statement.
BP STAFFING, INC DOES NOT DISCRIMINATE BECAUSE OF SEX,
AGE, HANDICAP, RACE, CREED AND NATIONAL ORIGIN.