Ventry Staffing Application Form

Last 4 numbers of SSN: Salutation: *First Name: Middle Initial: Last Name: Nickname: Address: *City: *State: *Zip: *Home Phone (Enter only numbers, area code first): Cell Phone (Enter only numbers, area code first): Other Phone (Enter only numbers, area code first): Email: In case of emergency, notify name: Emergency Phone (Enter only numbers, area code first): Check if you are legally authorized to work in the United States:

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City	Yes
City of Industry/Pomona
Mira Loma/Chino
Morena Valley/Perris
Ontario/Fontana/Rancho
Rialto/Colton
San Bernardino/Redlands

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Skill Set: 0010 ADMINISTRATIVE ASSISTANT	Yes
General
Medical
Legal
Marketing
Manufacturing
Financial
Skill Set: 0010 BOOKKEEPING
Assitant
Full Charge
Accts Payable
Accts Receivable
Collections
Reconciliation
Payroll
Tax Preparation
Software
Manual
Auditing
Budget Analysis
Invoicing
Skill Set: 0010 Office
Customer Service
Telemarketing-In
Telemarketing-Out
Filing
Mail room
Skill Set: 0010 Office Equipment
Typewriter
Copier
Fax
Postage Meter
Calculator
Projector
Computer
Email
Internet
Scanner
PDA
Skill Set: 0010 Receptionist
Switchboard
Headphone

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Enter as much information as you can. More details will help us better serve you. (Salary/Pay per hour: NOT REQUIRED in CA, DE, MA, OR, or NYC)

Previous Employment #1

Dates of Employment:

From:

To:

Name of Employer

Address:

City, State, Zip:

Phone:

Supervisor:

Job Position:

Pay per hour:

Reason For Leaving:

Previous Employment #2

Dates of Employment:

From:

To:

Name of Employer

Address:

City, State, Zip:

Phone:

Supervisor:

Job Position:

Pay per hour:

Reason For Leaving:

Previous Employment #3

Dates of Employment:

From:

To:

Name of Employer

Address:

City, State, Zip:

Phone:

Supervisor:

Job Position:

Pay per hour:

Reason For Leaving:

Previous Employment #4

Dates of Employment:

From:

To:

Name of Employer

Address:

City, State, Zip:

Phone:

Supervisor:

Job Position:

Pay per hour:

Reason For Leaving:

Temporary Employment

Check if you have ever used a recruiting firm to obtain employment:

Firm #1

Firm name:

Address:

City, State, Zip:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

Firm #2

Firm name:

Address:

City, State, Zip:

Please list at which clients you were placed, job category, and to whom you reported. Please share your thoughts on the agency and your assignment:

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High School Education

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I certify that the information on this application is true and factual.

Employee Application

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Enter as much information as you can. More details will help us better serve you. (Salary/Pay per hour: NOT REQUIRED in CA, DE, MA, OR, or NYC)

Previous Employment #1

Previous Employment #2

Previous Employment #3

Previous Employment #4

Temporary Employment

Firm #1

Firm #2

High School Education

Business or Other Education

College Education