Job Placement Application

This form should take about 10-20 minutes to fill out.

Please reach out to [email protected] If you have additional questions about this form.

3 Easy Sections

Personal & Background Information
- a few questions to help us get to know you better.
Commitment Letter
- a promise you sign to show you're ready to work with us to find a job.
Release of Information
- gives us permission to share your story to help you get hired.

Your responses will help us provide the most relevant job placement, and career opportunities tailored to your unique journey. Please answer honestly and thoroughly—your future starts here.

Section 1: Personal & Background Information

First Name *

First Name & Middle Initial

Last Name *

Date of birth

MM/DD/YYYY

What is your cell phone number?

What is your email?

Is this your personal contact information? *

Parents, Guardian or Friend

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (XXX) XXX-XXXX for assistance. You can reply STOP to unsubscribe at any time.

Address

Street Address

Including apt. number

City

State

Country

Postal code

Would you be willing to work Saturdays and Sundays? *

Yes

Are you willing to work graveyard shifts? *

Yes

ex. 12am-8am

Do you have a vehicle? *

Yes

Do you have a Drivers License? *

Yes

If no, please explain what steps you need to accomplish to recieve your Drivers License

Any entry level jobs you would completely avoid? *

A job that you would hate

If a formal background check is conducted what would the results be? *

short description of formal charges on your record with dates

Your most recent jobs *

Company name, job title, start date, end date, and reason for leaving job

If you could rank your top 3 career choices what would they be?

1. Electrician 2. Plumbing 3. Construction

What is your highest level of education? *

Any other important skills you would like to share with an employer

short description... please list any certificates you may have received or skills you have learned from UCI... For example: I can operate heavy machinery, I know how to weld, I know how to sew, I know how to program a CNC machine, etc.

Commitment Letter

I agree to work with Barder Staffing for 3 straight months to help me find a job.

If I find a job on my own, I will contact Barder Staffing before I start working, this way we can keep government programs in place for career strategies.
I will be a responsible job seeker by doing the following
- showing up on time for interviews - 10 min early
- give prompt feedback after interviews
- update resumes for each job application
- respond to emails and texts in a timely manor.
I give my consent to Barder Staffing to record and share video content for the purpose of creating more interview opportunities.
I understand this work will help me get an entry level job to help me on my future career path.

Commitment Date *

MM/DD/YYYY

Commitment Signature *

Clear

By signing your Full Name in the box above, you consent to the use of your typed name as your electronic signature

Release of Information

I give permission to Barder Staffing to share information about my past with employers who may want to hire me.

This includes talking about:

My criminal record
What happened in my case
What I have done to move forward and change
Why I am ready to work and be a good employee

I understand that this information will only be shared to help me get a job.

I know that I can stop this permission at any time by telling Barder Staffing in writing.

I am signing this form because I want help finding a job and I trust Barder Staffing to use this information the right way.

Date *

MM/DD/YYYY

Release of Information Signature *

Clear

By signing your Full Name in the box above, you consent to the use of your typed name as your electronic signature