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Please Note: Required fields are marked with an asterisk (*).
The character '&' is not allowed.
 
Things You Will Need to Complete This Application:
  • Emergency contact info - name, phone, address
  • Doctor's name, address, and phone number (optional)
  • Employment record for past four jobs - Dates, address, phone, salary, supervisor name
  • Educational history for high school and college - school name, city, years, degree
  • Three references (not relatives or past supervisors) including address and phone
  • If you'd like to include your resumé, please email it to us
 
General Information - Part 1 of 6
First Name*
Middle Name*
Last Name*
Other Name (Maiden/Married)
How many years did you use that name?
Social Security No.* (numbers only)
 
 
The following three questions pertain to applicable annual Federal EEO-1 reports. Information received will not be used in any way to evaluate the employee.
Sex* Male Female
Ethnicity
Marital Status
Date of Birth* (MM/DD/YYYY)
 
Address*
City*
State*
Zip*
How Long?*
Phone Number*
Email*
 
Prior Address
City
State
Zip
How Long?
 
Driver's License #*
Driver's License State*
Military Veteran?* Yes No
 
In case of emergency notify:  
Name*
Relationship*
Phone Number*
 
Type of Job Desired*
 
What salary or rate of pay do you expect to receive if employed? $ per
 
 
Medical Information - Part 2 of 6
MPN (Medical Provider Network) * I want to enroll in the MPN (Medical Provider Network) program for my medical care for any work-related injury or illness. I have received information about the Health Care Organization offered by my employer and want to enroll in the MPN Program.

I do NOT want to enroll in the MPN. I want my personal physician, personal chiropractor, or personal acupuncturist to treat me for any work-related injury or illness. My personal physician, personal chiropractor, or personal acupuncturist is (fields to right are required if you select this option):

I do not want to enroll in the MPN or designate a personal physician, personal chiropractor, or personal acupuncturist to treat me for any work-related injury or illness. I understand that my employer will enroll me in the MPN program for treatment of any work-related injury or illness.
Doctor's Name
Phone
Address
City
State
Zip
 
 
Employment Information - Part 3 of 6
Have you ever worked for iLink Business Management before?* Yes No
If yes, please give employment dates
 
Are you able to perform the essential functions of the job, with or without reasonable accommodations?* Yes No
 
Have you ever been convicted of a crime?* Yes No
If yes, please explain.
Note: You do not need to identify convictions that have been sealed, expunged, dismissed, or otherwise eradicated by statute or court order, any conviction for marijuana offense if the conviction is more than two years old, or any information pertaining to any offense which did not result in conviction as a result of referral to and participation in any pre-trial or post-trial diversion program.
 
May we contact your past employers for verification purposes?* Yes No
If no, please explain.
Please explain any periods of non-employment.
Available Start Date* (MM/DD/YY)
 
Do you have any doctor / court / other appointments in the next 30 days? If yes, which dates?
 
Employment History
Begin with current or most recent job
Date From* (MM/DD/YY)
Date To* (MM/DD/YY)
Job Title*
Company Name*
Address*
City*
State*
Zip*
Phone*
Hours per week*
Total Worked* (Yrs/Months)
Salary Earned* $ per
Duties Performed*
Supervisor Name*
Reason for Leaving*
 

 
Employment History - Continued
Date From (MM/DD/YY)
Date To (MM/DD/YY)
Job Title
Company Name
Address
City
State
Zip
Phone
Hours per week
Total Worked (Yrs/Months)
Salary Earned $ per
Duties Performed
Supervisor Name
Reason for Leaving
 

 
Employment History - Continued
Date From (MM/DD/YY)
Date To (MM/DD/YY)
Job Title
Company Name
Address
City
State
Zip
Phone
Hours per week
Total Worked (Yrs/Months)
Salary Earned $ per
Duties Performed
Supervisor Name
Reason for Leaving
 

 
Employment History - Continued
Date From (MM/DD/YY)
Date To (MM/DD/YY)
Job Title
Company Name
Address
City
State
Zip
Phone
Hours per week
Total Worked (Yrs/Months)
Salary Earned $ per
Duties Performed
Supervisor Name
Reason for Leaving
 
 
Educational History - Part 4 of 6
High School Name*
City*
State*
Did you graduate?* Yes No
 
College Name
City
State
Years Attended
Have you graduated? Yes No
Degree
 
Other School Name
City
State
Years Attended
Have you graduated? Yes No
Degree
 
 
References - Part 5 of 6

Please list three persons who are not related to you, and are not previous supervisors.
Name*
Address*
Phone*
Occupation*
Years Known*
 

 
Name*
Address*
Phone*
Occupation*
Years Known*
 

 
Name*
Address*
Phone*
Occupation*
Years Known*
 
 
Skills - Part 6 of 6

Please mark your current skills*
General Skills
English Spanish Steel Toe Shoes 1st Shift
2nd Shift 3rd Shift Machine Operator Type of Transportation:
 
Warehouse Skills
Active Forklift Certification Equipment Operator Forklift Experience / Driver Garment Processing
Garment Ticketing General Warehouse / Labor Janitorial / Cleaning Exp Load and Unload Merchandise
Order Pulling Picker / Packer Production / Assembly Line Receiving
RF Scanner Sewing Machine Shipping UPS / Fedex Shipping
 
Skilled
Accounting Customer Service Electrical Experience Front Desk Clerical
Human Resources Lead Person Manager Maintenance
Accounts Payable Accounts Receivable MS Excel / MS Word Quality Control
Supervisor Bobcat Driver Security Guard Guard Card
Dispatcher Payroll CSR Call Center
 
 
Rancho Cucamonga
Hesperia
City of Commerce
Pico Rivera
Midvale, Utah
Ontario
  909.581.1000
760.244.5111
323.900.0619
323.900.0619
801.401.3547
Coming in 2015