Welcome to Members staffing Agency
  • 9025 Kenyon Avenue
    Denver, CO 80237
  • +1 720 382 6008
    info@memberstaffing.com
  • 10:00am to 6:00pm
    Sunday Closed

Staff Registration Form

PERSONAL INFORMATION

AVAILABILITY

Weekends   Days   Evenings   Nights   Flexible
Yes   No  

EDUCATION

College(Name) College(City / State)
College(Graduate?) College(Degree)
High School(Name) High School(City / State)
High School(Graduate?) High School(Degree)
Other(Name) Other(City / State)
Other(Graduate?) Other(Degree)

PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

Type Organization or State Issues
Date Issued Number
Facility / Verification

JOB RELATED SKILLS

Yes   No  
Yes   No  

MILITARY RECORD

Military Rank Entry Rank
Separation Rank Separation Date(s)
Military Occupational Specialty

Incident Date City / State
Charge

Yes   No  
Yes   No  
Yes   No  

SECURITY

Yes   No  
Yes   No  

EMPLOYMENT HISTORY
(List current (or most recent) employer first and all others in reverse chronological order.)

Company Name Dates Employed
Address City
State Zip Code
Position Job Description
Phone Number Immediate Supervisor's Name
Immediate Supervisors Title Reason for leaving

Yes   No  

REFERENCES

LIST THREE REFERENCES OF SUPERVISORS AND ASSOCIATES WHO ARE FAMILIAR WITH YOUR WORK ABILITIES (THAT ARE NOT RELATIVES)

Reference 1
Name and Relationship
Title
Company and Address
Telephone Number
Reference 2
Name and Relationship
Title
Company and Address
Telephone Number
Reference 3
Name and Relationship
Title
Company and Address
Telephone Number