Affordable Staffing Application

When you are finished filling the form, press the "Submit" button at the bottom.,
and the information will be sent directly to us.


 Last First  Middle Initial 






Social Security number:



Home  Cell 


  Years Completed  Graduated?  College Degree?

Full / Part Time:

What Kind  of Work?"

Hourly Rate Preferred:

      First Shift Second Shift Third Shift

Preferred Shift

Preferred Locations (cities):

When Can You Start?:

Do You have Transportation?:

Do You have a Resume?:

Work History:

                                                   List your last 5 jobs






      Reason for Leaving






Birthday (Month / Day):


Emergency Contact :

      Phone Number:    Relationship to you:   

Do You Have:

     Driver's Licence?  Birth Certificate?  SSCard? 

Bond Status:

     Have you ever been Bonded?     Are You Eligible to be bonded?

Physical Limitations:

      Do You Have Physical Limitations?  If Yes, What? 

I certify that the information submitted on this application is accurate and current. I hereby allow AFFORDABLE STAFFING permission to verify my employment history and to solicit and secure any other information required to determine the suitability of my employment with AFFORDABLE STAFFING. I furthur authorize the above named employers to release to AFFORDABLE STAFFING such information as may be requested for the purpose of evaluating me for possible employment. A copy of this authorization with my signature has the same force and effect as the original violations of AFFORDABLE STAFFING policies including, but not limited to:

(1) Two unexcused absences or two no shows with call (not going to work after accepting the assignment but notifying AFFORDABLE STAFFING within a half hour before/after starting time)

(2) If you have an unexcused absence you will recieve the minimum pay rate for the week,

(3) One no show, no call (not going to the assignment and not notifying AFFORDABLE STAFFING)

(4) Three times being late to the assignment

(5) Insubordination

(6) Behavior or language that reflects negatively on AFFORDABLE STAFFING and our employees

(7) Unauthorized possession of or removal of Company property, or involvement in any unlawful situation that could lead to questionable character.

(8) Drug or alcohol use on the job that impacts job performance.

(9)Falsification of information on this application.

By entering my name and date in the space below, I acknowledge that I have read the AFFORDABLE STAFFING policy regarding termination. I do realize that violation of any of the above will be just cause for my dismissal from AFFORDABLE STAFFING.

Enter Name Here Date

When the form is complete, press the "Submit" button, and the information will be sent directly to us.

To Print this for your records, press the "Print Page" button