Reliable Staffing Services, LLC is an equal opportunity employer and does not discriminate against applicants or employees on basis of sex, race, color, religion, national origin, ancestry or age (40 years of age and over). In addition, Reliable Staffing Services, LLC does not discriminate against qualified individuals with disabilities. Our online application uses 256-bit secure SSL encryption, to ensure that your information is safe and secure.
Applicant Information
	Questions marked by * are required.
	First Name: *	M.I.:	Last Name: *
	Street Address: *		Apartment/Unit #:
	City: *	State: *	Zip Code: *
	Phone: *		Alternate Phone:
	Email:		Date Available:
	Social Security #: *		Desired Salary: *
	Position Applied for: *
	Are you authorized to work in the United States? * Yes No	If so, do you have written evidence of legal right to work in the United States? * Yes No
	Have you ever worked for this company? Yes No	If so, when?
	Have you ever been convicted of a crime? * Yes No	If yes, explain:
Education
	High School: *	Address:
	Years Completed:	Graduate? Yes No	Degree:
	College:	Address:
	Years Completed:	Graduate? Yes No	Degree:
	Other:	Address:
	Years Completed:	Graduate? Yes No	Degree:
References
	Full Name: *	Relationship: *
	Company:	Phone: *	Address:
	Full Name:	Relationship:
	Company:	Phone:	Address:
	Full Name:	Relationship:
	Company:	Phone:	Address:
Previous Employment
	Company *	Phone:	Address:
	Supervisor:		Job Title:
	Starting Salary:		Ending Salary:
	Responsibilities:
	Dates:	Reason for Leaving:
	May we contact your previous supervisor for a reference? Yes No
	Company:	Phone:	Address:
	Supervisor:		Job Title:
	Starting Salary:		Ending Salary:
	Responsibilities:
	Dates:	Reason for Leaving:
	May we contact your previous supervisor for a reference? Yes No
	Company:	Phone:	Address:
	Supervisor:		Job Title:
	Starting Salary:		Ending Salary:
	Responsibilities:
	Dates:	Reason for Leaving:
	May we contact your previous supervisor for a reference? Yes No
Emergency Contact Information
	Name: *	Relationship: *
	Phone: *	Address:
Resume
	If you would like to submit your resume along with this application, please upload it using the field below.
Disclaimer
	I certify that all facts contained in the application are true and complete and acknowledge that Reliable Staffing Services, LLC is relying on the accuracy of the information provided. I authorize Reliable Staffing Services, LLC to verify the accuracy of the information provided herein, and I authorize former employers, educational institutions and credit agencies to release information concerning me to Reliable Staffing Services, LLC. I also authorize Reliable Staffing Services, LLC to give references and provide information about me in response to inquiries subsequent to my employment if hired. I understand that falsification, misrepresentation or omission of requested facts may result in denial of employment or, if employed, may result in immediate dismissal and/or legal prosecution. I also understand that I am required to abide by all rules and regulations of Reliable Staffing Services. I agree to take any lawful medical examination required by Reliable Staffing Services, LLC as a condition of being hired, or if I am hired, as a condition of continued employment. I agree that my refusal to take any such lawful examinations or sign a client’s confidentiality agreement may be cause for termination of my employment. I authorize investigation of my credit, driving, criminal, and employment history as required by Reliable Staffing Services as a condition of my being hired, or, if I am hired as a condition of continued employment. I release all persons or companies conducting any lawful investigation or medical examination from any liability. I understand and agree that, if hired, my employment will be for no definite period and may, regardless of the date of payment of wages, be terminated at any time without previous notice and with or without reason, at the will of either myself or Reliable Staffing Services, LLC. I also understand and agree that no one has authority to promise me job security or continued employment, except the CEO of the Company in a formal written agreement signed by both of us. Reliable Staffing Services, LLC is an equal opportunity employer. The company does not discriminate against age, race, color, creed, religion, sex, national origin, disability or other protected class or characteristic established under applicable federal, state or local statue or ordinance. Reliable Staffing Services, LLC does not accept applications from minors. I understand and agree that, if placed, I will be responsible for a $38.00 application fee, which will be deducted from my first paycheck. By clicking "Submit", you agree to these terms.