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Employment Application

Please fully complete this application or your application will not be considered. If something doesn’t apply to you, enter NA for Not Applicable.

If you would like to fill out an application in person, applications are only taken on Tuesday – Thursday from 9 A.M. to 11A.M.

  • APPLICANT INFORMATION

  • The following Question is optional
  • Date Format: MM slash DD slash YYYY
  • EDUCATION

    Provide information for school attended below. Include name of school, location (Complete mailing address), Years completed, and Degree/Diploma.
  • CERTIFICATIONS AND TRAINING

  • MEDICAL INFORMATION

  • EMPLOYMENT EXPERIENCE

    Please provide all information for the last 5 years of employment starting with the most recent.
  • MILITARY SERVICE RECORD

  • Out of Town Travel

    If you work out of town, you will receive $25.00 a day per diem. The company pays for the room and provides transportation in company vehicles. There is absolutely no drinking during or after work hours when you are out of town. No visitors in rooms will be permitted. If any rules or policies are broken, that is grounds for termination. If you are let go and your only way home is a bus, Kelly's Industrial Services will pay for the ticket and deduct it from your check.
  • APPLICATION STATEMENT

    I certify that all information I have supplied in this application and in any other form, oral or written, is true, complete and accurate. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect will be sufficient cause to (a) cancel further consideration of this application or (b) immediately discharge me from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, Kelly’s Industrial Services, its representatives, employees, and / or agents to contact and obtain information from all references (personal and professional), employers, and public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume’, or job interview. I also give permission for criminal / motor vehicle background checks. I hereby waive any and all rights and claims I may have regarding Kelly’s Industrial Services, its representatives, employees and / or agents for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me, but understand my right to privacy shall be respected and the inquiries treated in confidence. I understand Kelly’s Industrial Services does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law. If I am hired, I understand that my employment will be at will. This means that I am free to resign at any time, with or without cause and without prior notice, and Kelly’s Industrial Services reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid. I understand Kelly’s Industrial Services maintains a drug-free workplace and agree that maintenance of same is essential to the safety of the workplace and employees. I promise to abide by the agency’s policies prohibiting the use or possession of drugs, alcohol, or any controlled substance, or the misuse of prescribed or over-the-counter medication on agency premises or while on duty. I understand also that I may be tested for drugs, alcohol, or controlled substances if I am employed by Kelly’s Industrial Services If I am hired, I agree to comply with and be bound by Kelly’s Industrial Services safety and health rules and regulations, rules of conduct, and any other rule or procedure set forth by my employer. I understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 form in this regard.
  • Items in RED are required.
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