Employment Application | Kaye Personnel Staffing

Application - Initial Interview

Step 1 of 10

Demographic Information
THIS APPLICATION IS A LEGAL DOCUMENT AND MUST BE COMPLETED BY THE APPLICANT ONLY. BE SURE TO FILL OUT EACH AREA IN ITS ENTIRETY. Applications are active for 12 months.
Applicant Name*
First Middle Last
Have you been employed under any other name?*
- Yes
- No
If so, what name?
Nickname
Social Security Number*
Home Address*
Street Address City State ZIP Code
Do you have an alternate address?*
- Yes
- No
Alternate Address:
Street Address City State ZIP Code
Email Address*
Home Phone*
Work Phone
Cell Phone
Other Phone
Please Specify:

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Reference Check
To be completed by Applicant only.
Release of Information
I hereby authorize Kaye Personnel, Inc. to thoroughly investigate my references, work records, driving record, credit history, education, and other matters related to my suitability for employment and, further, authorize my current and former employers to disclose to the company any and all letters, reports, and other information pertaining to my employment with them, without giving me prior notice of such disclosure. I understand that all information obtained will be held in confidence and acknowledge that a copy of my facsimile of this document carries the same validity as the original. In addition, I hereby release Kaye Personnel, Inc., my current and former employers, and all other persons, corporations, partnerships, and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.
Applicant Signature*

Type Your Full Name

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Acknowledgements
•••Please initial in the boxes- don't put a check mark! If there is any part of this page you do not understand, please ask the interviewer about it.•••
1. In order to be placed for work, I understand that I must be telephone accessible. I will notify Kaye Personnel, Inc. if my contact information changes*
1. In order to be placed for work, I understand that I must be telephone accessible. I will notify Kaye Personnel, Inc. if my contact information changes
2. I understand that I am an employee of Kaye Personnel, Inc., and only I or Kaye Personnel, Inc. can terminate my employment. When an assignment ends, I must contact Kaye Personnel,Inc. within 1 business day for my next job assignment. I need to follow up with Kaye Personnel, Inc. weekly for assignments. Failure to do so will result in being considered a voluntary quit.*
2. I understand that I am an employee of Kaye Personnel, Inc., and only I or Kaye Personnel, Inc. can terminate my employment. When an assignment ends, I must contact Kaye Personnel,Inc. within 1 business day for my next job assignment. I need to follow up with Kaye Personnel, Inc. weekly for assignments. Failure to do so will result in being considered a voluntary quit.
3. I understand that I am expected to complete any job assignment I accept. If I do not complete the assignment, then Kaye Personnel, Inc. can assume that I have voluntarily quit.*
3. I understand that I am expected to complete any job assignment I accept. If I do not complete the assignment, then Kaye Personnel, Inc. can assume that I have voluntarily quit.
4. If for any reason, such as emergency or illness, I can not make it to work or will be late, I will contact Kaye Personnel, Inc. prior to my designated start time. My failure to do so may be grounds for dismissal, and/or indicate that I have quit.*
4. If for any reason, such as emergency or illness, I can not make it to work or will be late, I will contact Kaye Personnel, Inc. prior to my designated start time. My failure to do so may be grounds for dismissal, and/or indicate that I have quit.
5. I understand that Kaye Personnel, Inc. pays employees weekly, that the pay period is Monday to Sunday, and that my pay will be directly deposited into my bank account or on to a BB&T pay card issued by Kaye Personnel, Inc. for the previous pay period*
5. I understand that Kaye Personnel, Inc. pays employees weekly, that the pay period is Monday to Sunday, and that my pay will be directly deposited into my bank account or on to a BB&T pay card issued by Kaye Personnel, Inc. for the previous pay period
6. I understand that Kaye Personnel, Inc. will not recognize or pay for any hours worked by an employee which are not reported on an individual or group time sheet, signed by both the client and the employee. I also understand that in order to be paid in a timely manner, time tickets must be turned in no later than noon each Monday for the previous week . Any late tickets will not be paid until the next pay period.*
6. I understand that Kaye Personnel, Inc. will not recognize or pay for any hours worked by an employee which are not reported on an individual or group time sheet, signed by both the client and the employee. I also understand that in order to be paid in a timely manner, time tickets must be turned in no later than noon each Monday for the previous week . Any late tickets will not be paid until the next pay period.
7. I am aware that many clients of Kaye Personnel, Inc. require background checks for all temporary employees assigned to their companies. I give Kaye Personnel permission to conduct this background check. understand that this information is confidential and will be used for employment purposes only.*
7. I am aware that many clients of Kaye Personnel, Inc. require background checks for all temporary employees assigned to their companies. I give Kaye Personnel permission to conduct this background check. understand that this information is confidential and will be used for employment purposes only.
8. I understand and will comply with the Kaye Personnel Safety Rules and Policy Statement and Safety Orientation video, and will also comply with the client's safety regulations and policies as well. If I have any questions regarding safety, I will address them to my supervisor. I understand that some positions may require safety equipment, which will be provided to me, and a deposit withheld*
8. I understand and will comply with the Kaye Personnel Safety Rules and Policy Statement and Safety Orientation, and will also comply with the client's safety regulations and policies as well. If I have any questions regarding safety, I will address them to my supervisor. I understand that some positions may require safety equipment, which will be provided to me and a deposit withheld
9. If I sustain an injury on the job, I will inform the client and Kaye Personnel,Inc. immediately after the accident. Under no circumstances will I report the injury later than the end of the shift on which it occurred. Kaye Personnel, Inc. will coordinate with the client and myself, the proper procedure for treatment and reporting of the accident. Unauthorized medical treatment will not be covered by Kaye Personnel,Inc.*
9. If I sustain an injury on the job, I will inform the client and Kaye Personnel,Inc. immediately after the accident. Under no circumstances will I report the injury later than the end of the shift on which it occurred. Kaye Personnel, Inc. will coordinate with the client and myself, the proper procedure for treatment and reporting of the accident. Unauthorized medical treatment will not be covered by Kaye Personnel,Inc.
10. Kaye Personnel prohibits harassment or discrimination based on race, color. religion, creed, gender, age, national origin, marital status, physical or mental disability, or any other legally protected status. I understand that if I observe such conduct or feel that I am a victim of such harassment or discrimination, I should report any incident immediately to my supervisor. I also understand that participation in any form of harassment or discrimination is against company policy, and may result in disciplinary action and/or discharge.*
10. Kaye Personnel prohibits harassment or discrimination based on race, color, religion, creed, gender, age, national origin, marital status, physical or mental disability, or any other legally protected status. I understand that if I observe such conduct or feel that I am a victim of such harassment or discrimination, I should report any incident immediately to my supervisor. I also understand that participation in any form of harassment or discrimination is against company policy and may result in disciplinary action and/or discharge.
11. Kaye Personnel's policy prohibits our employees from being under the influence of illegal drugs or alcohol while on assignment at a client's facility. Kaye also prohibits the use, sale or possession of such substances. I understand that my failure to comply with this agreement will be grounds for my immediate termination.*
11. Kaye Personnel's policy prohibits our employees from being under the influence of illegal drugs or alcohol while on assignment at a client's facility. Kaye also prohibits the use, sale or possession of such substances. I understand that my failure to comply with this agreement will be grounds for my immediate termination.
12. I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the basis for termination. I hereby authorize this company to investigate my background inclusive of criminal records and verify this information. Iunderstand that if employed, my employment will not be for any fixed period of time and may be terminated by the company at any time. I also authorize this company to release the information contained herein and its findings and work history of my employment to other firms or persons upon request. I also understand and agree that I may be expected to work on a wide variety of job assignments in the South Jersey area and agree to accept assignments for which I am qualified as they become available. I also understand my failure to report for work will indicate I have quit. I also agree to submit to a drug screen upon request or as specified in Kaye Personnel, lnc.'s substance abuse policy.*
12. I hereby declare that all statements contained in this application are true and correct and understand that false or inaccurate information in the application will be the basis for termination. I hereby authorize this company to investigate my background inclusive of criminal records and verify this information. I understand that if employed, my employment will not be for any fixed period of time and may be terminated by the company at any time. I also authorize this company to release the information contained herein and its findings and work history of my employment to other firms or persons upon request. I also understand and agree that I may be expected to work on a wide variety of job assignments in the South Jersey area and agree to accept assignments for which I am qualified as they become available. I also understand my failure to report for work will indicate I have quit. I also agree to submit to a drug screen upon request or as specified in Kaye Personnel, lnc.'s substance abuse policy.
13. I have read and fully understand the above statements regarding Kaye Personnel, Inc. policies and procedures and agree to the same. I understand that my failure to comply with these policies and procedures could lead to my termination and may jeopardize my insurance or unemployment benefits.*
13. I have read and fully understand the above statements regarding Kaye Personnel, Inc. policies and procedures and agree to the same. I understand that my failure to comply with these policies and procedures could lead to my termination and may jeopardize my insurance or unemployment benefits.
14. I have been given the Kaye Personnel Field Associate Handbook. It is my responsibility to read and understand the contents of the handbook and abide by the policies and rules as stated and described in the handbook.*
14. I have been given the Kaye Personnel Field Associate Handbook. It is my responsibility to read and understand the contents of the handbook and abide by the policies and rules as stated and described in the handbook.
15. I understand that the following point system is in effect immediately: Late: 2 points, Insubordination: 3 points, Leaving work area without approval: 3 points, Poor attitude towards work or co-workers: 1 point, Disruptive behavior: 3 points, Unexcused absence: 3 points, Excused absence no more than 2 in a 30 day period: 2 points. You must notify Kaye Personnel of court appearances 1 week in advance. If one week's notice is not given your absence will be considered unexcused. I understand that a total of 5 points in a 30 day period will result in termination and points stay on record for a period of 30 days then will be disqualified.*
15. I understand that the following point system is in effect immediately: Late: 2 points, Insubordination: 3 points, Leaving work area without approval: 3 points, Poor attitude towards work or co-workers: 1 point, Disruptive behavior: 3 points, Unexcused absence: 3 points, Excused absence more than 2 in a 30 day period: 2 points. I understand that I must notify Kaye Personnel of court appearances 1 week in advance. If one week's notice is not given your absence will be considered unexcused and points charged accordingly. I understand that a total of 5 points in a 30 day period will result in termination and points stay on record for a period of 30 days then will be disqualified.
Applicant Signature*
Date*
MM slash DD slash YYYY

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Point System
The following point system is in effect immediately, and the following guidelines are set forth in order to help our employees understand how and why they are disciplined. The system encompasses all Kaye Personnel employees, including the leads. Kaye Personnel Management handles all disciplinary actions, and questions or concerns regarding this policy should be directed to a Kaye Personnel Staffing Specialist.
Points can be accumulated for the following reasons:
1. Late: 2 points
2. Insubordination: 3 points
3. Leaving work area without approval : 3 points
4. Poor attitude towards work or co-workers: 1point
5. Disruptive behavior: 3 points
6. Unexcused absence: 3 points
7. Excused absence (Doctor's appointment, court appearance) no more than 2 in a 30-day period: 2 points
  1. Dr.'s appointments should be scheduled during non-working hours. If you must make the appointment during work hours, you must bring a Dr.'s note to a Kaye Personnel office when you return.
  2. You must notify your Kaye Personnel Staffing Specialist of court appearances one week in advance. If one week's notice is not provided, your absence will be considered unexcused and points will be issued as stated above.
A total of points in a 30-day period will result in termination. Points will stay on record for a period of 30 days, then will be disqualified if no further instances occur. Please note: No call/ No Show will be grounds for immediate termination! You MUST contact us prior to your scheduled shift's start time if you will not be able to make it to work! NO EXCEPTIONS! I

I acknowledge receipt of this notification regarding the Kaye Personnel Point System. I will direct any questions concerning this notice to a Kaye Personnel Staffing Specialist. I understand a total of 5 points in a 30-day period will result in termination.
Applicant SIgnature*
Date*
MM slash DD slash YYYY

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DRUG SCREEN AUTHORIZATION AND CONSENT
I hereby give my consent to be drug and/or alcohol tested in accordance with the guidelines established in the KPI Drug and Alcohol Policy and understand that a refusal to submit to a test insofar as it is required by these guidelines, may be cause for disciplinary action up to and including discharge. I agree to hold harmless both KPI and the medical facility in regard to the effect the results of these tests may have on my employment. I authorize the disclosure of the test results as deemed necessary by KPI in accordance with the guidelines of this Policy . I additionally authorize the release of the test results and other pre-employment information (including reference check results) to client company involved for their permanent records. • Due to the cost of drug testing & background checks Kaye Personnel, Inc. requires at least two weeks of work when I am assigned to a company where drug testing and or background check is mandatory. • If I do not complete the two weeks of work, or my drug test comes back positive, Kaye Personnel will deduct the cost of the drug test ($35.00) from my pay • I understand Kaye Personnel will require a drug screen test whenever an on-the-job accident or injury is reported in accordance with Kaye Personnel's policy and this authorization and consent. My refusal to submit for drug testing will be grounds for termination.
Applicant SIgnature*
Date*
MM slash DD slash YYYY

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Medical Information Release Form
By my signature below, I authorize Kaye Personnel, Inc. to request and obtain all records regarding any work related accident and/or injury and/or occupational disease involving Kaye Personnel and myself. This is to include doctor's reports, follow-up reports, nurse's notes, medical bills, test results, etc. A fax or photocopy of this authorization shall be considered as effective and valid as the original. This release shall remain in effect until specifically rescinded by me.
Applicant Signature*
Date*
MM slash DD slash YYYY

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Release of Criminal Records
I do hereby authorize Kaye Personnel, Inc. to examine any and all criminal records and arrests on file in the counties in the State of New Jersey and any other state. In doing so, I understand that I am waiving my right of confidentiality concerning my criminal history.
Applicant SIgnature*
Date*
MM slash DD slash YYYY

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Application - Initial Interview

Step 1 of 10

Forms to download and complete

Initial Interview

Demographic Information

Referred By

General Info

Work History

Reference Check

Release of Information

Acknowledgements

Point System

DRUG SCREEN AUTHORIZATION AND CONSENT

Medical Information Release Form

Release of Criminal Records

New Jersey Location

Pennsylvania Location

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