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Locations Registration How did you hear ?* (Make Selection) Bing Search Career Builder Craig’s List Facebook Flyer Google Search Indeed Instagram LinkedIn MyExactJobs Referral Remote Recruiting Event SnapChat State Employment Office Twitter Please enter the referral source name* Have you ever worked with Exact Staff, Inc.?* Yes No When was the last time that you worked with us?* (format: MM/DD/YYYY) As a condition of employment, you may be required to pass a drug screen and or background check Are you able to take and pass a pre-employment drug screen?* Yes NoAre you at least 18 years old?* Yes No If no, can you submit a work permit if hired?* Yes No General Information Contact Information First Name * Middle Name Last Name * NicknameStreet Address *(NO P.O BOX) Apt. City * State * (Make Selection) Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington West Virginia Wisconsin Wyoming US Other : US Armed Forces: Pacific US Other : US Armed Forces: Europe US Other : US Armed Forces: America US Other : American Samoa US Other : Federated States of Micronesia US Other : Guam US Other : Marshall Islands US Other : North Mariana Islands US Other : Puerto Rico US Other : Virgin Islands Canada : Alberta Canada : British Columbia Canada : Manitoba Canada : New Brunswick Canada : Newfoundland Canada : Northwest Territories Canada : Nova Scotia Canada : Ontario Canada : Prince Edward Island Canada : Quebec Canada : Saskatchewan Canada : Yukon Territory Mexico : Aguacalientes Mexico : Baja California Mexico : Baja California Sur Mexico : Campeche Mexico : Coahuila de Zaragoza Mexico : Colima Mexico : Chiapas Mexico : Chihuahua Mexico : Distrito Federal Mexico : Durango Mexico : Guanajuato Mexico : Guerrero Mexico : Hidalgo Mexico : Jalisco Mexico : Mexico Mexico : Michoacan de Ocampo Mexico : Morelos Mexico : Nayarit Mexico : Nuevo Leo Mexico : Oaxaca Mexico : Puebla Mexico : Queretaro Artega Mexico : Quintana Roo Mexico : San Luis Potosi Mexico : Sinaloa Mexico : Sonora Mexico : Tabasco Mexico : Tamaulipas Mexico : Tlaxcala Mexico : Veracruz Mexico : Yucatan Mexico : Zaxatecas Zip Code * Primary Phone (format: xxx-xxx-xxxx) * Cell Phone (format: xxx-xxx-xxxx) Email address: We are committed to keeping your e-mail address confidential. The sole purpose of providing your e-mail is for immediate access to your pay stub and to receive your annual w-2. We do not sell, trade or lease e-mail address to any third parties. If a driver’s license is required for the position for which you are applying, do you have a valid driver’s license?* Yes NoDriver’s License Number Driver’s License State (Make Selection) Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington West Virginia Wisconsin Wyoming US Other : US Armed Forces: Pacific US Other : US Armed Forces: Europe US Other : US Armed Forces: America US Other : American Samoa US Other : Federated States of Micronesia US Other : Guam US Other : Marshall Islands US Other : North Mariana Islands US Other : Puerto Rico US Other : Virgin Islands Canada : Alberta Canada : British Columbia Canada : Manitoba Canada : New Brunswick Canada : Newfoundland Canada : Northwest Territories Canada : Nova Scotia Canada : Ontario Canada : Prince Edward Island Canada : Quebec Canada : Saskatchewan Canada : Yukon Territory Mexico : Aguacalientes Mexico : Baja California Mexico : Baja California Sur Mexico : Campeche Mexico : Coahuila de Zaragoza Mexico : Colima Mexico : Chiapas Mexico : Chihuahua Mexico : Distrito Federal Mexico : Durango Mexico : Guanajuato Mexico : Guerrero Mexico : Hidalgo Mexico : Jalisco Mexico : Mexico Mexico : Michoacan de Ocampo Mexico : Morelos Mexico : Nayarit Mexico : Nuevo Leo Mexico : Oaxaca Mexico : Puebla Mexico : Queretaro Artega Mexico : Quintana Roo Mexico : San Luis Potosi Mexico : Sinaloa Mexico : Sonora Mexico : Tabasco Mexico : Tamaulipas Mexico : Tlaxcala Mexico : Veracruz Mexico : Yucatan Mexico : Zaxatecas Emergency Contact Information Emergency Contact Name / Relationship* Phone Number (format: xxx-xxx-xxxx)* Additional Information Have you ever used another name? * Yes No NOTE: RESPONDING TO THE QUESTIONS BELOW IS VOLUNTARY. HOWEVER, ANSWERING THIS QUESTION WILL PERMIT EXACT STAFF TO MORE THOROUGHLY VERIFY YOUR EMPLOYMENT HISTORY, EDUCATION RECORD AND OTHER INFORMATION CONTAINED IN THIS APPLICATION AND EXPEDITE THE APPLICATION PROCESS. What other names have you used in the past? Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and education record? If Yes, please explain below: Resume - If you have a plain-text resume, paste it into the box below. Availability Are you willing to work temporary?* Yes No Are you looking for a full-time career position?* Yes No Are you willing to work overtime?* Yes No When are you available to start?* Month January Februrary March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2024 2025 Do you have reliable transportation to get to work every day?* (Select Option) Yes No What weekday hours are you available?* (Select Shift) First Shift Second Shift Third Shift All Shifts First and Second Shift First and Third Shift Second and Third Shift Not available What weekend hours are you available?* (Select Shift) First Shift Second Shift Third Shift All Shifts First and Second Shift First and Third Shift Second and Third Shift Not available How many hours are you willing to work in a week?* (Select hours) Part Time (0 to 20 hours a week) Full Time (More than 20 hours a week) What is the minimum pay you desire? (Hourly/Salary in US dollars) * How much notice will you need if a position is offered to you?* (Select Option) Same Day One Day One Week Need to Give Notice How many miles are you willing to travel to a position?* Nearest location* (Select Option) AZ, Surprise CA, Bakersfield CA, Central Valley CA, Fresno CA, Inland Empire CA, Los Angeles County CA, Merced CA, Newbury Park CA, Ontario CA, Orange County CA, Oxnard CA, Rancho Cucamonga CA, Riverside CA, Sacramento CA, San Fernando Valley CA, Santa Clara CA, Santa Clarita Valley CA, San Luis Obispo CA, Turlock CA, South Bay CA, Ventura County CA, Visalia CA, Woodland Hills CO, Denver CO, Pueblo IN, Indianapolis IN,...