ServiceXpress
APPLICATION OF EMPLOYMENT


It is the policy of this company to provide equal employment opportunities to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, physical or mental handicap or veteran status.

Es la política de esta compañía proporcionar posibilidades de empleo iguales a todas las personas calificadas sin respecto a la raza, al credo, al color, al estado de creencia de religiosa, del sexo, de la edad, del origen nacional, de la desventaja física o mental o a los veteranos.

Note: Please type or print your answers. If you print, please do so in blue or black ink and write neatly. An illegible application may preclude you from consideration.

Nota: Por favor escriba a máquina o imprima sus respuestas. Si imprime, hágalo en tinta azul o negra y escriba cuidadosamente. Una aplicación ilegible puede impedirte de ser considerado/a.


PERSONAL INFORMATION / INFORMACIÓN PERSONAL


Name / Nombre :
Middle Initial / Inicial :
Last Name / Apellido :

Address / Direccion:
Street and Apt. # / Calle y # de Apt
City / Ciudad :
State / Estado :
Zip Code / Codigo Postal :

Telephone / Telefono :

Cell Phone / Mobil :

Have you ever been convicted of a felony? /Te han condenado por un crimen?   		 Yes No

If answered yes, please explain / Si contestaste sí, explique por favor:   
Have you ever served in the U.S. Military? / ¿Has desempeñado servicios en los militares de Estados Unidos? Yes/Si No/No

If yes, Please provide the following information / Si sí, proporcionar por favor la información siguiente:

Branch of Service / Rama del servicio:

Rank at time of separation / Fila en la época de la separación:

I Served from/ Serví de : 		to :

Special Honors / Honores especiales:


In case of emergency contact/En caso de emergencia contacte a:

Name/Nombre:

Relationship/Relacion:

Phone Number/No. Telefonico:


EMPLOYMENT HISTORY / HISTORIA DE EMPLEO :


Present or Most Recent Employer / Presente o más reciente:


Employer/Empleador: 		  

Phone #/No. Tel:

Your Position/ Posición: 		  
Address/Direccion:

Employment Dates/Fechas de empleo:   

To:   

May we Contact?/ ¿Podemos contactarlo?
Yes/Si No/No

Reason for leaving?/ ¿Razonez de Irse?   



PRIOR EMPLOYER / EMPLEADOR ANTERIOR:

Employer/Empleador:
Phone #/No. Tel:

Your Position/ Posición:
Address/Direccion:

Employment Dates/Fechas de empleo:
To:

May we Contact?/ ¿Podemos contactarlo?
Yes/Si No/No

Reason for leaving?/ ¿Razonez de Irse?





EDUCATION / EDUCACIÓN

High School/Secundaria:
Name and Address/ Nombre y Dirección

Did you graduate? / Te Graduaste?
Yes/Si No/No

Attended From/Atendio de:
To/a:

If you did not graduate, did you receive your GED? Recibiste GED?
Yes/Si No/No

Special Honors or Awards/Honores o Premios

College or University/Universidad:
Name and Address/ Nombre y Dirección

Did you graduate?/Te Graduaste?
Yes/Si No/No

Attended from/Atendio de:
To/a:

Degree/Titulo:
Major/Principal:

Special Honors or Awards/Honores o premios:




Skills / Habilidades

Please describe any skill you have in the following areas / Describir cualquier habilidad que tenga en las areas siguientes:

Computer / Computadora:

Languages Spoken (other than English) / Idiomas (con exepcion de Español):


I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational and employment history. I hereby authorize this company to investigate my criminal background history and credit history (if Applicable).
Furthermore I understand that if I am hired, employment with is company is “at will” which means that either the company or I can terminate my employment for any reason not prohibited by state of federal law. Moreover, I understand that ServiceXpress offers temporary work only and that in any case my employment is probationary in nature for the first 90 days and that I can be terminated within the first 90 days for any reason.

Certifico por este medio que mis respuestas y aserciones dispuestas en este uso son verdades y completas al mejor de mi conocimiento. Si me emplean, entiendo que cualquier declaración falsa sobre este uso será considerada causa suficiente para mi despido. Autorizo por este medio a esta compañía a investigar cualquier aspecto de mi educación e historia de empleo anteriores. Autorizo por este medio a esta compañía a investigar mi historia criminal del fondo e historia del crédito (si fuera aplicable). Además entiendo que si me emplean, el empleo con esta compañía está “en la voluntad,” que significa que la compañía o yo puede terminar mi empleo por cualquier razón no prohibida por el estado o la ley federal. Por otra parte, entiendo que ServiceXpress me puede ofrecer trabajo temporal solamente y que en todo caso mi empleo es probatorio en la naturaleza para los primeros 90 días y que puedo ser terminado dentro de por 90 días por cualquier razón



Date

PRE EMPLOYMENT QUESTIONNAIRE


Name :

Adress:

Phone:
Mobile:

Position applied for:


PLEASE CIRCLE THE FOLLOWING QUESTIONS WITH A YES OR NO

Epilepsy ........................................................................................
Yes/Si No/No

Asthma ........................................................................................
Yes/Si No/No

High Blood Pressure ........................................................................................
Yes/Si No/No

Diabetes ........................................................................................
Yes/Si No/No

Stroke ........................................................................................
Yes/Si No/No

Heart attack ........................................................................................
Yes/Si No/No

Allergies ........................................................................................
Yes/Si No/No

Depression ........................................................................................
Yes/Si No/No

Other.......

Head injury ........................................................................................
Yes/Si No/No

Neck ........................................................................................
Yes/Si No/No

Back ........................................................................................
Yes/Si No/No

Low back ........................................................................................
Yes/Si No/No

If yes, please explain

Have you ever had any medical conditions in the past that caused you to miss work? If yes,please explain:

Have you ever been admitted to a hospital?
Yes/Si No/No

Have you ever had a surgery?
Yes/Si No/No

Do you have any physical conditions that prevent you to stand or sit for long periods of time?
Yes/Si No/No

Do you have any other problems?


I declare that all information provided is truthful.



Date



TEMPORARY LABOR

TERMS AND CONDITIONS OF EMPLOYMENT


I understand that I will be working on a temporary basis with SERVICEXPRESS

If your assignment is seasonal, and it ends we have the right to assign you to another job at any of our other client locations in Arkansas, at our sole discretion, and you agree to provide your own transportation to work at another location.

These locations may include:

Poultry plants

Animal food processing plants

Food or Pickling Plants

Driving Positions

You must contact us as soon as possible to make arrangement for your new assignments. Failure to do so, will result in automatic termination.

You also understand that you may be required to work day or night shift or have to take different tasks which in turn may result in pay rate changes (increase or decrease).

By accepting any assignment from us, you agree to accept these terms and conditions of employment.




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STANDARDS & RULES WE WORK BY


At Service General, we are excited to have you join our team. We are committed to quality work and superior customer service in every aspect of our business. Over time, we have learned what we need to do to maintain a high quality workplace and enable our associates (team members or employees) to provide superior service.

We hold all associates accountable to each other to work within four basic operating standards:

(1) RESPONSIBILITY/OWNERSHIP: All associates must take responsibility for their work and actions. You must make your own commitments and keep them.

(2) HONESTY/INTEGRITY: All associates must demonstrate exemplary integrity. The truth, the absolute truth – no sugar coating.

(3) VALUE/FAIRNESS: Value derives from providing real benefits to our clients and each other. Value therefore derives from a fundamental sense of fairness.

(4) SAFETY/QUALITY: We must make high quality operations an absolute priority. No short cuts, no patch ups. High quality means total safety orientation.

In our company manual (available at the office or on the internet www.servicexpressworks.net) we have provided specific rules that cannot be violated, which are based on these operating standards. Willful or wanton disregard of our company rules, or deliberate violations of our rules, or disregard for our standards of behavior, or gross negligence of duties will result in automatic dismissal at our company management’s sole discretion.

Below is a summary list of specific offenses mentioned in our manual that was provided to you upon hiring (in accordance with our operating standards):

RESPONSIBILITY/OWNERSHIP

* Taking unauthorized leave or failing to show up at work for more than three (3) consecutive days without notifying a supervisor; or Imprisonment

INTEGRITY/HONESTY

* Making false statements or omitting pertinent facts on an employment application or in an employment interview

* Stealing or deliberately damaging the company's or other employees’ property;

* Falsifying or destroying company documents or computer files;

* In the case of commercial drivers: Transporting unauthorized passengers in company vehicles

* In the case of salespersons: Salespersons who make false claims about the product or sell unauthorized products on company time.


FAIRNESS/VALUE

* Threatening, assaulting, fighting with, or harassing another employee or anyone else encountered during the course of business.


SAFETY/QUALITY

* Possessing a weapon at work.

* Reporting to work under the influence of alcohol, narcotics, or other drugs, unless the drug was prescribed for the employee by a physician.

We are all accountable to each other for our actions and behavior. Any associate may initiate an employee’s termination procedure however final employment decisions can only be made by designated management.

If there is any part of this that you do not understand, or need further explained feel free to contact me at anytime. My office door is open and you can also contact me on my cell pone (302) 245 3223 or by email: christine.atkins@servicegeneral.net



Date


Reference Sheet for :

Work/Professional Reference :

Name:

Phone number:

Relationship:

How long have you known them?

Notes:




Personal or Work/Professional Reference :

Name:

Phone number:

Relationship:

How long have you known them?

Notes:




Personal or Work/Professional Reference :

Name:

Phone number:

Relationship:

How long have you known them?

Notes:



PRIOR EMPLOYMENT AUTHORIZATION




I,    authorize ServiceXpress to contact and obtain informations regarding previous employment for future employment purposes including but not limited,employment dates,wage informations and recommendations.  

Date



WOTC QUESTIONNAIRE

Work Opportunity Tax Credit

Servicegeneral Corp. is participating in the WOTC program offered by the government. The program has been designed to promote the hiring of individuals who qualify as a member of a target group and to provide a Federal Tax Credit to employers who hire these individuals.

This questionnaire will assist ServiceGeneral Corp. is qualifying individuals for the WOTC. This program is on a voluntary basis and will not affect any hiring decisions. Thank you for your participation.



Applicant`s name

Last Name

First Name

Middle Initial

Government Identification Number:

▪ ID number can be any picture ID used in the I-9
▪ Examples: Driver`s license, State ID, INS, Passport, etc
Please answer Yes or NO to the following questions:

1. Have you ever been employed by ServiceGeneral Corp.?
Yes No


2. Are you between the ages of 16-39?
Yes No
      If yes, please provide your date of birth:


3. Are you a veteran of the U.S. Armed Forces? (if NO, go to question 4)
Yes No
    IF YES, are you a member of a family that received Supplemental Nutrition Assistance Program
    ( SNAP) benefits (Food Stamps) for at least 3 months during the 15 months before you were hired?
Yes No
            If YES, please provide name of primary recipient:
            and City and State where benefits were received:
            Case ID Number:
    Are you a Veteran entitled to compensation for a service-connected disability? Yes No
    Where you discharged or released from active duty within 1 year before you were hired? Yes No
    Where you unemployed for a combined period of at least 4 weeks but less than 6 months
    (whether or not consecutive) during the year before you were hired?		 Yes No
    *if you have your DD-214 readily available,please provide a copy to your Employer*


4. Are you a member of a family that received Supplemental Nutrition Assistance Program
    ( SNAP) benefits for the 6 months before you were hired?
Yes No
    Did you receive SNAP benefits for at least a 3-month period withing the last 5 months,
    but you are no longer receiving them?
Yes No
            If YES to either question, please provide name of the primary recipient:
            and City and State where benefits were received:
            Case ID Number:


5. Were you reffered to an employer by a Vocational Rehabilitation Agency approved by a State?
Yes No
    OR, by an Employment Network under the Ticket to Work Program? Yes No
    OR, by the Department of Veterans Affairs? Yes No
    Voc Rehab Agency Contact Name:
    Voc Rehab Agency Phone Number:


6. Are you a member of a family that received Temporary Assistance to Needy Families
    ( TANF) assistance for at least the last 10 months before you were hired?
Yes No
    Are you a member of a family that received TANF benefits for any 18 months beginning
    after August, 5, 1997, and the earliest 18-month period beginning after August 5, 1997,
    ss ended within 2 years before you were hired?		 Yes No
    Did you family stop being elibigle for TANF assistance within 2 years before you were
    hired because of a Federal of State law limited the maximum time those payments could be made?		 Yes No
            If YES to any question, please provide name of the primary recipient:
            and City and State where benefits were received:
            Case ID Number:


7.Were you convicted of a felony from prison after a felony conviction during     the year before you were hired?		                 Yes No
    If YES, please enter date of conviction and date of release
    Was this a Federal or a State conviction? Which State
    Department of Corrections ID Number
    Date Probation Began Date Probation Expires
    Parole Officer`s Name Parole Officer`s Phone Number


8.Did you receive Supplemental Security Income ( SSI ) benefits for any month
    ending within 60 days before you were hired?		                 Yes No
    SSI Contact Name:
    And SSI Contact Phone Number:

I certify that the information ir true and correct to the best of my knowledge. I understand that the information above may be subject to verification. I hereby authorize agencies, organization, or individuals to release requested information to MJA$ Associates. I understand that this information will be used solely for the purpose of qualifying my employer for the Work Opportunity Tax Credit program.

Date
    Print Name Phone Number

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