FIRST NAME (required)                 MIDDLE INITIAL                            LAST NAME (required)                  
                              

ADDRESS (required)                     CITY (required)                              STATE (required)        ZIP (required)
                                             

HOME PHONE (required)                OTHER PHONE                                EMAIL ADDRESS
                              

 I HAVE USED TOWER STAFFING, INC. IN THE PAST.

HAVE YOU EVER BEEN CONVICTED OF A CRIME?    YES NO

IF SO, PLEASE DESCRIBE BELOW:

CHECK ANY ITEMS YOU CURRENTLY OWN.

  SAFETY GLASSES
  WORK GLOVES
  STEEL TOE SAFETY SHOES
  LEATHER WORK SHOES
  HEARING PROTECTION
  HARD HAT

CHECK ANY THAT PERTAIN TO YOUR CURRENT WORK CONDITIONS.

  CAN LIFT OVER 75 POUNDS
  CAN LIFT OVER 50 POUNDS
  NO LIFTING OVER 30 POUNDS
  NO LIFTING
  NO STANDING

NUMBER OF YEARS EXPERIENCE (if no experience, leave field blank)

BUILDING MAINTENANCE (NUMBERS ONLY)

BUFFER MACHINE                               CARPET CLEANING MACHINE             FLOOR STRIPPING
                                       

HANDYMAN/REPAIR                         HEATING/COOLING                            HOSPITAL HOUSEKEEPING
                                       

MAINTENANCE/JANITORIAL              MOTEL/HOTEL HOUSEKEEPING           WAXING MACHINE
                                       

FACTORY WORK (NUMBERS ONLY)

ASSEMBLY LINE                                BENCH WORK                                    CUTTING TORCH
                                       

DEBURRING                                       DIE CASTING                                     FIBER GLASS
                                       

FIN MACHINE HELPER                        FOUNDRY WORK                                GENERAL SHOP HELPER
                                       

GLASS WORKER                                HAND GRINDER                                 MACHINE HELPER
                                       

MECHANICAL ASSEMBLY                  SEWING EXPERIENCE                         SOLDERING-HAND
                                       

SOLDERING-MACHINE                       TUBE BENDING                                   TUBE PUSHING
                                       

SUPERVISOR                                     PACKING                                           QUALITY CONTROL-MANUAL
                                       

QUALITY CONTROL-CALIPER             QUALITY CONTROL-MICROMETER      QUALITY CONTROL-USES SPC
                                       

QUALITY CONTROL-VISUAL               QC-COORD MEASURING MACH          QC-GEOM TOLER DIMENSION
                                       

MACHINES OPERATIONS (NUMBERS ONLY)

OPERATOR-BRAKE PRESS                OPERATOR-ROLL THREADER             OPERATOR-PLASTIC EXTRUDER
                                        

OPERATOR-TAPPERS                       USES PRECISION MEASURING INST.    OPERATOR-BRAKE MACHINE
                                       

OPERATOR-CUT OFF SAW                OPERATOR-DRILL PRESS                   OPERATOR-GRINDER MACHINE
                                       

OPERATOR-LATHE                           OPERATOR-MILL                                OPERATOR-PLASTIC INJECTION MOLD
                                       

OPERATOR-PUNCH PRESS                OPERATOR-RADICAL DRILL              OPERATOR-SANDING MACHINE
                                       

OPERATOR-SCREW MACHINE           OPERATOR-SHEAR MACHINE            OPERATOR-STAMPING PRESS
                                       

OPERATOR-STRIPPIT MACHINE        OPERATOR-TURRET LATHE                OPERATOR-CNC
                                       

STOCK ROOM (NUMBERS ONLY)

COMPUTER INVENTORY                     EXPEDITOR                                        FACTORY STOCK ROOM
                                       

KARDEX INVENTORY                         KNOW ELECTRONIC COMPONENT        PHYSICAL INVENTORY
                                       

RETAIL STOCK ROOM                        WAREHOUSE STOCK ROOM
                   

FOOD SERVICES (NUMBERS ONLY)

BAKER                                               CAFETERIA                                        CASHIER-FOOD SERVICES
                                       

COOK                                                 DELI EXPERIENCE                              DISHWASHER
                                       

FAST FOOD                                        FOOD SERVER                                    FOOD SERVICE GENERAL
                                       

HOTEL EXPERIENCE                            SALAD PREP
                   

WAREHOUSE (NUMBERS ONLY)

STANDUP FORKLIFT CERT                  FORKLIFT OPERATOR CERT                FORKLIFT OPERATOR NON-CERT
                                       

STANDUP FORKLIFT NON-CERT          MATERIAL HANDLER                         PALLET JACK OPERATOR
                                       

SHRINK-WRAP MACHINE OPERATOR

WELDING (NUMBERS ONLY)

BRAZE/SOLDER                                BURNER OPERATOR                           CODE
                                       

FIT-UP                                               FLUXCORE                                         HELIARC
                                       

MIG                                                   SPOT                                                 SPRAY ARC
                                       

STICK                                                SUB-ARC                                           TIG
                                       

TORCH/CUTTERS                               RESISTANCE/INDUCTION                   ALUMINUM
                                       

DRIVERS (NUMBERS ONLY)

BUS                                                  COMMERCIAL DRIVER LICENSE          DOT CERTIFIED
                                       

LOCAL                                              OVER THE ROAD                                ROUTE SALES
                                       

STATE CHAUFFER                              TYPE "A" SEMI TRUCK                       TYPE "B" STRAIGHT TRUCK
                                       

MAILROOM (NUMBERS ONLY)

BINDER WORKER                              BULK MAIL SORTING                          BURSTER MACHINE OPERATOR
                                       

FOLDING MACHINE OPERATOR           MAIL CLERK                                     MAIL-FILE SORTING
                                       

POSTAGE MACHINE OPERATOR        POSTAL REGULATIONS
                   

SHIPPING/RECEIVING (NUMBERS ONLY)

C.R.T. EXP-LITE TYPING                    EXPRESS MAIL SHIPPING EXP           FREIGHT WEIGHT EXP
                                       

INTERNATIONAL TRANSPORT EXP     LOCAL TRANSPORT EXP                    PACKING/SORTING
                                       

SHIP/RECEIVE GENERAL                   STATE TRANSPORT EXP                     UPS SHIPPING-ONLINE EXP
                                       

AGRICULTURE (NUMBERS ONLY)

CARCASS EXPERIENCE                      DETASSLING EXPERIENCE                  DRIVE-FARM EQUIPMENT
                                       

GENERAL FARM LABOR                     LIVESTOCK
                   

WOODWORKING (NUMBERS ONLY)

MATERIAL HANDLER                        TENON MACHINE                                 HAND SANDER
                                       

OFFBEARER                                       WHITEWOOD INSPECTOR                   FINISH INSPECTOR
                                       

CNC ROUTER                                     TABLE SAW                                       BAND SAW
                                       

DRILL PRESS                                    EDGE SANDER                                    SCREWDRIVER OPERATOR
                                       

GLUE WHEEL                                     DRUM SANDER                                  MOULD SANDER
                                       

SPRAYING STAIN                             SPRAYING LACQUER                          SPRAYING TOPCOAT
                                       

SPRAYING SEALER                           WIPING STAIN                                   SEALER SANDER
                                       

TOPCOAT SANDER                            TOP RUBBER                                      INSTALL HARDWARE
                                       

PACKER                                            TOP PRESS                                        UPHOLSTERER
                                       

JACK OPERATOR                               TRIM NAIL OPERATOR                       WOOD FABRICATOR
                                       

PRINTING (NUMBERS ONLY)

BINDERY WORK                                BULK SORTING                                   COLLATOR OPERATOR
                                       

FOLDING MACHINE                            INSERTER OPERATOR                        LAMINATING MACHINE
                                       

LINE SORTING                                   PRESS OPERATOR HELPER                 PRESS OPERATOR
                                       

TYPESETTER                                     WEB PRESS ASSISTANT                     2-COLOR PROCESS
                                       

4-COLOR PROCESS                           CUTTER/OPERATOR                           EMBROIDERY TECH
                                       

SCREEN PRINTING

OTHER SKILLED (NUMBERS ONLY)

EQUIPMENT OPERATOR                     EXCAVATING EQMNT OPERATOR        STATIONARY ENGINEER
                                       

FLEET MANAGER                               PLUMBER-JOURNEYMAN                    PLUMBER
                                       

ELECTRICIAN-JOURNEYMAN

MISCELLANEOUS (NUMBERS ONLY)

DRY CLEANERS                                 ELECTRICAL HELPER                         GREENHOUSE WORKER
                                       

HEALTH CARE AID                            LAUNDRY                                          OPTICAL EQUIPMENT
                                       

PLUMBER HELPER                             POWER TOOLS                                   SECURITY GUARD
                                       

CONSTRUCTION (NUMBERS ONLY)

AFRAID OF HEIGHTS                         CARPENTER                                       CONCRETE WORKER
                                       

CONSTRUCTION-COMMERCIAL          CONSTRUCTION-INDUSTRIAL             CONSTRUCTION-RESIDENTIAL
                                       

CREW LEADER                                  DRYWALL EXPERIENCE                     FOUNDATION EXPERIENCE
                                       

MASONRY                                         ROOFING                                           SIDING EXPERIENCE
                                       

STRUCTURAL STEEL                          TOWER CLIMBING (100' +)
                   

PAINTER (NUMBERS ONLY)

AIRLESS SPRAY                               BRUSH                                              COMMERCIAL
                                       

DIP                                                   ELECTRO STATIC                                INDUSTRIAL
                                       

ROLLER                                             POLISH/BUFF FINISH                         RESIDENTIAL
                                       

SANDBLASTER                                  SPRAY