Prairie Staffing

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• Position Applied For:
• Are you a citizen of the United States? Please select an option Yes No
• If no, are you authorized to work in the U.S.? Please select an option Yes No
• Have you ever worked for this company? Please select an option Yes No
• If so, when?
• Have you ever been convicted of a felony? Please select an option Yes No
• If yes, explain?
• * Driver's License #:
• Are you willing to work any shift, including nights and weekends?
• If no, please state any limitations:

• Education

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• References

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• Previous Employment

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• May we contact your previous supervisor as a reference? Please select an option Yes No
  
  
  
  
• Company:
• Phone:
• Address:
• Supervisor:
• Job Title:
• Starting Salary:
• Ending Salary:
• Responsibilities:
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• Reason for leaving:
• May we contact your previous supervisor as a reference? Please select an option Yes No
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  Applicant Skills: List any skills that may be useful for the job you are seeking. Enter the number of year of experience and enter the number that corresponds to your ability for each particular skill. (One represents poor ability while five represents exceptional ability.)
• Skill:
• Years of Experience:
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• Skill:
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• Ability Rating:
  
  
• Skill:
• Years of Experience:
• Ability Rating:
  
  

• Military Service

• Branch:
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• Rank at Discharge:
• Type of Discharge:
  
  
• If other than honorable, explain:
  
  

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