Name *

First Name

Last Name

Phone *

(###)

###

####

Are you 18 or older? *

Yes

No

Are you legally able to work in the U.S.? *

Yes

No

Have you previously worked for Arizona Staffing? *

Yes

No

Availability

Day Shift

Afternoon

Night Shift

OT

Date *

Date Available to Start

MM

DD

YYYY

Do you have any responsibilities/activities that may interfere with you working overtime, evening and/or nights? *

Yes

No

Are you willing to submit to a background check? *

Yes

No