Job Application Form

Position Applying For/City*

First Name*

Last Name*

Email*

Phone*

Address*

City*

ST*

Zip*

Emergency Contact Name*

Relationship

Have you previously worked for Sunrise Staffing Services, LLC?

If yes, list dates*

Have you ever been convicted of a Felony?

If yes, explain

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Education

High School: Name - City, ST*

Dates Attended

Did you graduate?

Degree/Majors*

College: Name - City, ST*

Years Completed*

Dates Attended*

Did you graduate?

Years Completed*

Degree/Majors

Other: Name - City, ST

Dates Attended*

Did you graduate?

Years Completed*

Degrees/Majors*

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Work History

Company Name*

City and State*

Position*

Dates Employed

Name and Title of Supervisor*

Company Phone Number*

Exact Duties You Performed*

Reason For Leaving

Company Name

City And State*

Position*

Dates Employed

Company Phone Number*

Name and Title of Supervisor*

Exact Duties You Performed*

Reason for Leaving*

Company Name*

City and State*

Position*

Dates Employed*

Name and Title of Supervisor*

Company Phone Number

Exact Duties You Performed*

Reason For Leaving*

Additional Information*

I agree to travel up to a 30-mile radius without mileage compensation

The applicant agrees that this agreement is made in the State of Kansas and governed by the laws of the State of Kansas, except where Conflict of Laws Rules may refer this agreement to another state. The applicant further agrees to submit to the exclusive jurisdiction of the District Court of Seward County, Kansas, for any disputes arising from this agreement or your employment with Sunrise Staffing Services, LLC. The applicant, by tsigning this form, agree that Sunrise Staffing Services, LLC may contact all references and employers listed. Information found to be false, now or at a later date, will be cause for instant dismissal.

I have informed Sunrise Staffing Services, LLC of any physical/mental conditions and medication I am taking which may affect my safety or the safety of others while on assignment.

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Sunrise Staffing Services, LLC does not discriminate against any individual on the basis of race, sex, religion, national origin, citizenship, age, or disability. Being convicted of a felony does not exclude you from being considered for employment.

Signing this agreement means you understand and agree to all of the above.*

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Sunrise Staffing Services, LLC

Liberal, KS Location

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Great Bend, KS Location

Dodge City, KS Location

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Garden City, KS Location

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