Fax

1.  What type of work are you interested in obtaining?

Office

Industrial

Distribution Center

Call Center

Tech.
/Prof.

Medical

Other

Explain job interest (Please be specific). 

2.  Are you available to work?

Full-time

Work-to-hire

Summer only

Permanent 
(Direct Hire Only)

Hours and days available (Please be specific):

3.  Per hour salary requirements: $

4.  For what company were you last employed?
    
     How long?

5.  What was the last date that you were employed?
     

6.  Why was your last job ended?

7.  Per hour pay at time job ended: $

8.  Do you have a verifiable 5 year work history?     Yes     No

9.  Have you ever worked for or applied with any Bright Services
      office location?     Yes     No

      If yes, when and at what location?

10.  How far will you travel to work? (miles one way)

11.  What is your mode of transportation for getting to and from
         work?

12.  How long have  you been a resident of the state in which you
        reside?         

        If  less that one (1) year
        please give full previous address
       

13.  Do you have a valid Driver's License for the State in which you reside?           Yes     No

        Do you have your valid Social Security card?  Yes     No

14.  Are you legally eligible for employment in the United
        States?  Yes     No

        Are you currently drawing unemployment compensation?
        Yes     No

        If yes, weekly amount.$  End Date

15.  Are you able to pass a same-day safety/drug/criminal court
        check?     Yes     No