Please enable JavaScript in your browser to complete this form. - Step 1 of 4Applicant's InformationName *FirstMiddleLastGenderMaleFemaleAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone Number *Email AddressDate of Birth *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Social Security Number *Salary desired *I'll accept my state minimum wage$10 - 11 per hour$11 - 12 per hour$12 - $13 per hour$13 - $14 per hour$14 - 15 per hour$15 - 18 per hour$18 - 20 per hour$20 - 25 per hour$25 per hour or morePosition Applied forDo you consent to a Criminal Background Check? *YesNoWere you explained and do you understand what a 1099 contractor is? *YesNoDo you understand this is a Temp to Perm. position? *YesNoAre you a citizen of the United States? *YesNoAre you authorized to work in the U.S.? *YesNoPlease attach a photo of your Alien Registration card. Click or drag a file to this area to upload. Have you ever worked for this company? *YesNoHave you done a physical lately?YesNoDate physical was doneAre you able work without any restrictions? *YesNoIf no, please explain.Have you ever been convicted of a felony? *YesNoIf your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any risk of disciplinary action or revocation of your offer of admission.If yes, please explain.Are you a veteran of the U.S. Military?YesNoNextEducationHigh School NameHigh School AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDid you graduate from High School?YesNoHigh School Graduation DateDid you attend college?YesNoCollege NameCollege/University AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDid you graduate from college?YesNoCollege Graduation DateNextEmployment History and SubmissionsMost Recent EmployerMost Recent Employer's AddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeJob TitleFromToStarting Salary$7 - 8 per hour$8 - 9 per hour$9 - 10 per hour$10 - 11 per hour$11 - 12 per hour$12 - $13 per hour$13 - $14 per hour$14 - 15 per hour$15 - 18 per hour$18 - 20 per hour$20 - 25 per hour$25 per hour or moreEnding Salary$7 - 8 per hour$8 - 9 per hour$9 - 10 per hour$10 - 11 per hour$11 - 12 per hour$12 - $13 per hour$13 - $14 per hour$14 - 15 per hour$15 - 18 per hour$18 - 20 per hour$20 - 25 per hour$25 per hour or moreResponsibilitiesList the job description, hours per week, and other pertaining details here.Reason for LeavingMay we contact your previous supervisor for a reference? *YesNoAttach a resume if you have one. Click or drag a file to this area to upload. Attach a cover letter if you have one. Click or drag a file to this area to upload. Upload a copy of your Driver's license or ID * Click or drag a file to this area to upload. Upload a copy of your Social Security Card. * Click or drag a file to this area to upload. Certification and SignatureDo you certify that the information you provided in your application is true? *Yes, I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.Signature *Clear SignatureNextHarassament Policy Receipt and Acknowledgement Form At TA Personnels, we strive to create and maintain a healthy and diverse work environment where our employees like spending time at. For those reasons, we prohibit any type of behavior such as humiliation, inappropriate talk, non respectful attitude, discrimination and generalization and other. Acting in such way has a huge negative impact on employees well-being and work performance, and is considered harassment. With the attempt to eliminate this type of behavior at TA Personnels, for every action we consider harassment, we take corrective actions. This employee harassment policy applies to all TA Personnels LLC employees, contractors, public visitors, vendors and clients. What is harassment in the workplace? Some of the most common workplace harassment actions include: Sexual harassment Discriminatory harassment Unwelcome sexual advances Requests for sexual favors Coerced sexual acts Comments on a person’s ethnic heritage and religious beliefs If employee experiences any of these situations, incident should be reported to their supervisor or to the Human Resources department as soon as possible. Disciplinary Consequences Every harassment action, when determined and proved, will be subject to serious disciplinary and corrective action. Some of the most common disciplinary actions include, but are not limited to: Counseling Warnings Suspensions Termination Do you understand and agree to the terms listed above? *Yes, I acknowledge that I have received the TA PERSONNELS Policy on Harassment. I understand that it is my responsibility to be familiar with and conform to the procedures contained in this policy. I am expected to abide by the rules and requirements contained in the policy with regard to the reporting of harassment, including the obligation to report violations of the policy and not to retaliate against anyone for exercising his/her rights under this policy. Signature *Clear SignatureNameSubmit