Employment Application
Please print. Do not complete the shaded areas.
Personal Information
Social Security/Tax ID No. Professional Title Last Name (Full legal last name)
Redmond
(e.g., CPA, Esq., MD, PhD)
***-**-****
First Name (Full legal first name) Middle Name Preferred Name (Nickname)
James
Other Legal Name Used Dates Other Name Used (MM/DD/YYYY) Are you authorized to work in the United States?
none From / / To / / q Yes q No
Other Legal Name Used Dates Other Name Used (MM/DD/YYYY) Are you under the age of 18?
From / / To / / q Yes q No
Telephone No. Ext. Telephone Type Telephone Notes
903-***-**** q Cellular q Home q Work q Pager
Alternate Telephone No. Ext. Telephone Type Preferred Method of Contact
q Cellular Phone q Home Phone q Work Phone
208-***-**** q Cellular q Home q Work q Pager q Email q Text Message q Pager
Email Address Email Address Type Email Notes
*******.******.**@*****.*** q Business
q Personal
Alternate Email Address Email Address Type
q Business
*****.*******@***.*** q Personal
In case of emergency, notify: Telephone No. Ext. Telephone Type Emergency Contact Notes
Kathy Redmond 903-***-**** q Cellular q Home q Work q Pager
Driver’s License No. (May be required for certain background screenings.) State/Prov. of Issue Expiration Date (MM/DD/YYYY)
Applicants in Utah: Do not complete.
TX
150*****-**/30/2014
/ /
Recruiting Source (How did you learn about Kelly and/or this position?) Recruiting Source Note Last Step Completed
Primary Job Code Primary Job Title Job Code Job Title
Address (Enter all addresses for the past 10 years [may be required for certain background screenings]. If you need more space, use an additional sheet of paper.)
Current Address Paycheck/Stub Address q Check if same as current Previous Address
Address Apt./Box No. Address Apt./Box No. Address Apt./Box No.
1053 E. Ashford St.
2898 Hwy. 271 So.
City City City
Meridian
Gilmer
County State/Prov. County State/Prov. County State/Prov.
ID
TX
Country Postal/ZIP Code Country Postal/ZIP Code Country Postal/ZIP Code
83642
USA 75645 USA
From (MM/YYYY) To (MM/YYYY) From (MM/YYYY) To (MM/YYYY) From (MM/YYYY) To (MM/YYYY)
03/2013 01/2014
01/2014
/ / / / / /
Indicate the area/cross streets near your current address
2 miles south of Gilmer, Tx..nearest cross street is Birdsong.
Previous Address Previous Address Previous Address
Address Apt./Box No. Address Apt./Box No. Address Apt./Box No.
7955 Lancelot Dr. 6750 Pacal Road
City City City
Pensacola Gilmer
County State/Prov. County State/Prov. County State/Prov.
Escambia FL TX
Country Postal/ZIP Code Country Postal/ZIP Code Country Postal/ZIP Code
USA
USA
From (MM/YYYY) To (MM/YYYY) From (MM/YYYY) To (MM/YYYY) From (MM/YYYY) To (MM/YYYY)
02/1994 05/2010
05/2010 03/2013
/ / / / / /
For additional Hiring Process Kits, order Item 4900. Printed in U.S.A. 4901 R6/13
Education (If you need more space, use an additional sheet of paper.)
Education Level (Check all that apply.) Discipline (Check all that apply.)
q No Diploma College/University (No Degree) Juris Doctor (Law) q Arts Law
q q q
q GED Associate’s Degree Pharm D (Doctor of Pharmacy) q Business Science
q q q
q High School (Diploma) Bachelor’s Degree Doctorate/Other Professional Degree q Education Social Science
q q q
q Trade School Master’s Degree Post-Doctorate q Engineering Other:
q q q
q Vocational School Doctor of Philosophy (PhD) Other: q Health/Medical
q q
q Business School MD (Medical Doctor) q Information Technology
q
School/Institution Name School/Institution Name
Woodlawn High
City State/Prov. Country City State/Prov. Country
AR USA
Rison
Status Dates Attended (YYYY) Status Dates Attended (YYYY)
q Completed (Graduated) q Completed (Graduated)
1970 1974
q In Progress q Not Pursuing From To q In Progress q Not Pursuing From To
Date or Expected Date of Graduation/Completion (MM/DD/YYYY) GPA Date or Expected Date of Graduation/Completion (MM/DD/YYYY) GPA
/ / / /
Course of Study (Major/Minor) Course of Study (Major/Minor)
Manufacturing
Level Verified Note Level Verified Note
q Yes q Yes
Résumé
q Electronic
Work Experience (Include employment with Kelly and enter most recent employer first. Complete even if a résumé is submitted.) q Paper q None
Employer Name Employer Name Employer Name
Dept. of Corrections General Electric [Landrum Staffing] Handyman Service
q Current Employer q Former Employer q Current Employer q Former Employer q Current Employer q Former Employer
Job Title Job Title Job Title
Electrical Foreman Owner
Battery Box Specialist
Is this employer a staffing company? q Yes q No Is this employer a staffing company? q Yes q No Is this employer a staffing company? q Yes q No
If yes, at what company(s) were you assigned? If yes, at what company(s) were you assigned? If yes, at what company(s) were you assigned?
(Enter most recent/significant positions) (Enter most recent/significant positions) (Enter most recent/significant positions)
Pay Rate/Salary Pay Rate/Salary Pay Rate/Salary
600.00 WEEK 15.00 HOUR 400.00 WEEK
$ Per $ Per $ Per
Start (MM/YYYY) End (MM/YYYY) Start (MM/YYYY) End (MM/YYYY) Start (MM/YYYY) End (MM/YYYY)
10/2012 05/2011
10/2013 01/2014 05/2011 06/2010
/ / / / / /
Supervisor/Manager Name Supervisor/Manager Name Supervisor/Manager Name
Tobe Thompson Crista Walderbach James Redmond
Supervisor/Manager Title Supervisor/Manager Title Supervisor/Manager Title
maint. superv. Site Supervisor Owner
Address Address Address
14601 So. Pleasant Valley Road 8200 Scenic Hwy. 7955 Lancelot Dr.
City State/Prov. City State/Prov. City State/Prov.
Boise ID Pensacola FL Pensacola FL
Country Postal/ZIP Code Country Postal/ZIP Code Country Postal/ZIP Code
USA 83601 USA 32514 USA 32514
Telephone No. Ext. Telephone No. Ext. Telephone No. Ext.
208-***-**** Job Duties Job Duties Job Duties
Repairs to industrial kitchen and laundry Charge, repair and test battery boxes to be Repairs to household appliances, basic HVAC
equipment, worked crew of inmates, repairs to all loaded on railroad cars to ship products. repairs, carpenter, plumbing and electrical
appliances on compound. repairs I started this company because there
we no jobs at this time]
Reason for Leaving Reason for Leaving Reason for Leaving
Returned to East Texas [own home here] Reduction of temp. workers.. Went to General Electric Plant
Verified Date (MM/DD/YYYY) Verified With Verified Date (MM/DD/YYYY) Verified With Verified Date (MM/DD/YYYY) Verified With
/ / / / / /
Verified Note Verified Note Verified Note
References (Enter information for three work-related references.)
Name Name Name
Joey Barton Tony Leslie Richard Bell
Reference Type Reference Type Reference Type
q Educational q Personal q Work q Educational q Personal q Work q Educational q Personal q Work
Current Title Current Title Current Title
welder Manager
General Manager
Company Name Company Name Company Name
Austal Sure Alloy Steel Corp. Apex Plastics
Location (City, State/Prov., and Country) Location (City, State/Prov., and Country) Location (City, State/Prov., and Country)
Mobile, Al. USA Longview, Tx., USA Brookfield, Mo. USA
Telephone No. Ext. Telephone No. Ext. Telephone No. Ext.
850-***-**** 903-***-**** 660-***-****
) ) )
Fax No. Fax No. Fax No. Email Address Email Address Email Address
*****@************.***
**********@****************.***
Verified Date (MM/DD/YYYY) Verified Date (MM/DD/YYYY) Verified Date (MM/DD/YYYY)
/ / / / / /
Note Note Note
Referrals Kelly Services actively seeks talented and qualified individuals who match the skills and experience our customers require. If you know someone you think would be a great Kelly
employee, please list them here. You may be eligible for a referral bonus ask your Kelly representative for details.
Name Name Name
Current Employer and Title Current Employer and Title Current Employer and Title
Telephone No. Ext. Telephone No. Ext. Telephone No. Ext. Email Address Email Address Email Address
May we use your name when contacting this person? May we use your name when contacting this person? May we use your name when contacting this person?
q Yes q No q Yes q No q Yes q No
Preferences
Maximum Commute Distance Maximum Commute Time Desired Pay Rate/Salary Minimum Pay Rate/Salary Quoted Pay Rate/Salary
Miles Minutes $ Per $ Per $ Per
Work Type Desired Check the methods by which Kelly may contact you regarding marketing information
(To change or “opt out” of any selection at a future date, notify your Kelly Representative in writing.)
q Temporary/Contract q Temporary-to-Hire q Direct-hire q Email q Mail q Telephone (including automated calls) q Text Message
Geographic Location (In which local area(s) do you prefer to work or not work?) Note
q Work In/Near q Not Work In/Near
q Work In/Near q Not Work In/Near
Company Name/Work Location (If you have a preference to work or not work for a specific company, indicate below.) Note
q Work For q Not Work For
q Work For q Not Work For
Work Schedule (Check the days you are able to work.) Shift(s) Available Preferred Shift(s)
q Mon. – Fri. q Mon. q Tue. q Wed. q Thu. q Fri. q Sat. q Sun. q First q Second q Third q First q Second q Third
Part-Time Hours Date Available to Start (MM/DD/YYYY) Duration of Availability (How long are you able to work for Kelly?)
q A.M. q A.M.
From: q P.M. To: q P.M. / / q Days q Weeks q Months q Indefinitely
Seasonal Help (Available only during vacation Minimum Notice Required ASAP Work Schedule Note
and holiday periods.) (How much notice do you require prior to starting a position?)
q Yes q No q Hours q Days q Weeks q
Travel (Are you willing to travel?) Relocate (Are you willing to relocate?) Work From Home (Are you interested in
q Yes If Yes, how often? % q Yes If Yes, indicate state(s): working from home?)
q No q No q Yes q No
Preferred Language Transportation Method (How will you get to work?) Transportation Note
q Car q Public Transportation q Ride q Other
Agreement
General Information Communication and Information Systems User Agreement
I understand I may be offered employment with Kelly Services, Inc. (“Kelly”), subject to I understand communication and information systems belonging to Kelly and/or Kelly’s
my availability for work, Kelly’s ability to find suitable assignments for me, and results of customer (such as email, Internet, intranet, voicemail, fax machines, and the like) are
reference checking or other employment-related screening procedures. I understand intended for legitimate business purposes and I have no privacy when using these systems.
job-related background and/or drug screening may be a condition of my employment, Any personal use is at the sole discretion of Kelly and/or Kelly’s customer. Access to and use
assignment, or reemployment. of these systems may be terminated at any time without notice. The use of communication
and information systems in an inappropriate or offensive manner (including sexually explicit
For the purposes of this Agreement, “customer(s)” and “potential customer(s)” of Kelly
words or images, racial epithets or slurs, and/or demeaning words or images that may be
shall mean any entity to which I have been assigned by Kelly, or have been exposed
considered offensive to others) is prohibited.
through Kelly-arranged interviews, meetings, or recruiting efforts.
Release for Consent to Contact
My employment term with Kelly is not guaranteed and is considered to be “at will.” Kelly
I authorize Kelly to notify me of employment opportunities and other Kelly-related
or I may end the relationship at any time, with or without cause, subject to applicable
information using any method of contact I provided (including, but not limited to, email,
laws. The duration of any assignment I accept depends on the needs of Kelly’s customer
text messages, and/or telephone). I further authorize Kelly to send these notifications
and may be canceled at any time by Kelly or the customer.
using any method of transmission (automated or otherwise). I understand that normal
Kelly will provide me with the details of any assignment I accept. If the customer
carrier/transaction fees may occur based on my individual service provider.
significantly changes the responsibilities of my assignment, I will promptly notify Kelly.
Termination of Employment/Assignment End
Kelly will pay me for my work while assigned to Kelly’s customer. If Kelly overpays me,
Upon completion of each assignment, I will notify Kelly of my availability for work. I
Kelly may deduct such overpayment from any proper compensation it owes me, where
understand I am responsible for maintaining weekly contact with Kelly. Failure to contact
legally allowed.
Kelly may affect my eligibility for unemployment benefits. I understand that once fourteen
The terms of this agreement are applicable during any periods of employment with Kelly,
days have passed after my last paycheck date, my employment with Kelly will be terminated
including any period of reemployment after my first employment term with Kelly has ended.
unless I have been placed on another assignment or qualified leave of absence. I also
Authorization and Release for Reference Checks and Verification understand that I may be eligible for reemployment.
of Information Limitations on Actions
I authorize Kelly to conduct work-related reference checks and verify all information using I agree to bring any claims that I may have against Kelly within 300 days of the day that
all sources provided on the Employment Application and all related documents (in any I knew, or should have known, of the facts giving rise to the cause of action and waive
form) (“Application”) and I release all parties from all liability resulting from the use of any longer, but not shorter, statutory or other limitations periods. This includes, but
information that can be lawfully obtained. is not limited to, the initial filing of a charge with the Equal Employment Opportunity
Release of Personal Information Commission and/or state equivalent civil rights agency. However, I understand that I will
thereafter have the right to pursue any federal claim in the manner prescribed in any right
I authorize Kelly to collect, use, store, transfer, and purge the personal information I have
to sue letter that is issued by an agency.
provided exclusively for employment-related purposes. (Note: Kelly’s Privacy Statement is
available upon request.) Choice of Law and Jurisdiction and Forum
Employment Relationships I understand any disputes related to this Application, Agreement, and/or my employment
relationship with Kelly shall be governed by the laws of the State of Michigan (the location
I understand I am not an employee of any customer to which Kelly assigns me, regardless
of Kelly’s world headquarters), regardless of conflicts of law principles. Any action arising
of any customer statement, conduct, or belief. I will not be eligible to participate in or to
out of this Application, Agreement, or relationship between me and Kelly established
receive benefits from any customer’s benefits plans or policies. I waive and reject all rights
herein shall be brought only in the State of Michigan Courts of appropriate venue, or the
to receive, apply for, or participate in any customer’s benefits plans or policies.
United States District Court sitting in Michigan, and I consent to and submit myself to the
Confidentiality and Non-Disclosure jurisdiction of such Courts.
During any periods of employment, I may be exposed to confidential and proprietary
Successors and Assigns and Entire Application
information and trade secrets of Kelly and/or Kelly’s customer (“Confidential Information”).
The provisions contained in this Application and Agreement shall be binding upon Kelly
This Confidential Information includes, but is not limited to, Kelly’s and/or Kelly’s
and its respective successors and/or assigns, and upon me and any of my heirs, personal
customer’s existing or prospective customer or employee lists, operational procedures,
representatives, and/or assigns (except that my duties under the terms of this Application
marketing and sales strategies and practices, pricing information, customer and prospect
and Agreement may not be delegated). This Application and Agreement represent the
needs and preferences information, and employee training information and practices.
entire understanding between Kelly and me regarding its contents. Any alteration or
I agree that all Confidential Information, whether originals, copies, or in electronic media
modification of this Application or Agreement shall not be valid unless in writing and signed
or other forms, is the exclusive property of Kelly and/or Kelly’s customer. Without Kelly’s
by Kelly and me. Kelly and I agree that if any portion of this Application and/or Agreement
or its customer’s written permission, I will not publish, use, copy, retain possession of, or
is held invalid or unenforceable, the remaining portions shall remain in full force and effect.
disclose (directly or indirectly) in any way to anyone any Confidential Information. I will not
I understand my violation of any of the provisions contained in this Application and/or
improperly make use of Confidential Information, both during any periods of employment
Agreement may result in ineligibility for hire or reemployment, discipline, or termination
with Kelly and at any time after any periods of employment with Kelly terminate. Upon
of assignment or employment. Additionally, if I violate any of these provisions in this
completion of any assignment and/or termination of any periods of employment with
Application and/or Agreement, Kelly has the right to seek any and all legal remedies and
Kelly, I will return to Kelly or Kelly’s customer all Confidential Information and property of
damages, including monetary damages. I agree to pay any and all legal fees, including,
Kelly and/or its customer.
without limitation, all reasonable attorneys’ fees, court costs, and any other related fees and/
Assignment of Intellectual Property Rights or costs incurred by Kelly in enforcing the provisions of this Application and/or Agreement.
I understand I acquire no property rights or claim to the Confidential Information or any
Truthfulness of Information
other property of Kelly and/or its customer and that ownership of any work I create during
All of the information provided by me in support of my application for employment is true
any periods of employment or while on any assignment with Kelly will belong to Kelly and/
and complete. Any false, misrepresented, or omitted information may result in ineligibility
or its customer. My work during any periods of employment or on any Kelly assignment
for hire or reemployment, discipline, or termination of assignment or employment.
shall be considered “work for hire.” I will assign any intellectual property rights that arise
from my work to Kelly and/or its customer. I have read this Application and Agreement, I understand it, and I agree to its terms.
Non-Solicitation James Redmond
I acknowledge Kelly’s need to protect its existing and potential customer and employee Name (Printed)
relationships, protect its Confidential Information, and protect itself against improper
or unfair competition. I agree I will not (directly or indirectly) during any periods of
James Redmond:8023
employment and for 12 months from the date my last assignment ends, for any reason: (a) 4/2/2014
Solicit or attempt to solicit any Kelly employee; and (b) Solicit or attempt to solicit from Signature Date
Kelly any work or business from any customer or potential customer of Kelly.
I acknowledge these restrictions are reasonable and necessary to protect Kelly’s operations,
legitimate competitive interests, and Confidential Information. I recognize the highly Kelly Representative’s Name (Printed)
competitive nature of Kelly’s business and the irreparable harm that my violation of these
restrictions would cause.
Kelly Representative’s Signature Date
For additional Hiring Process Kits, order Item 4900.
An Equal Opportunity Employer Printed in U.S.A. © 2013 Kelly Services, Inc. Y0757 Supply #4901 R6/13
Education (If you need more space, use an additional sheet of paper.)
Education Level (Check all that apply.) Discipline (Check all that apply.)
High School (No Diploma) Associate’s Degree Pharm D (Doctor of Pharmacy) Arts Law
High School (Diploma/GED) Bachelor’s Degree Doctorate/Other Professional Degree Business Science
Trade School Master’s Degree Post-Doctorate Education Social Science
Vocational School Doctor of Philosophy (PhD) Engineering
Other: Other:
Business School MD (Medical Doctor) Health/Medical
College/University (No Juris Doctor (Law) Information Technology
Degree)
School/Institution Name School/Institution Name
City State/Prov. Country City State/Prov. Country
Additional Work Experiences
Dates Attended (YYYY) Dates Attended (YYYY)
Status Status
Completed (Graduated) Completed (Graduated)
From To From To
In Progress Not Pursuing In Progress Not Pursuing
Date or Expected Date of Graduation/Completion (MM/DD/YYYY) Date or Expected Date of Graduation/Completion (MM/DD/YYYY)
GPA GPA
/ / / /
Course of Study (Major/Minor) Course of Study (Major/Minor)
Level Verified Note Level Verified Note
Yes Yes
Résumé
Electronic
Work Experience (Include employment with Kelly and enter most recent employer first. Complete even if a résumé is submitted.) Paper None
Employer Name Employer Name Employer Name
General Dynamics Trinity Rail Clad Tec [SAS Corp]
Current Employer Former Employer Current Employer Former Employer Current Employer Former Employer
Job Title Job Title Job Title
maintenance technician maintenance technician maintenance technician/purchasing agent
Is this employer a staffing company? Yes No Is this employer a staffing company? Yes No Is this employer a staffing company? Yes No
If yes, at what company(s) were you assigned? If yes, at what company(s) were you assigned? If yes, at what company(s) were you assigned?
(Enter most recent/significant positions.) (Enter most recent/significant positions.) (Enter most recent/significant positions.)
Pay Rate/Salary Pay Rate/Salary Pay Rate/Salary
15.85 HOUR 17.35 HOUR 14.15 HOUR
$ Per $ Per $ Per
Start (MM/YYYY) End (MM/YYYY) Start (MM/YYYY) End (MM/YYYY) Start (MM/YYYY) End (MM/YYYY)
06/2010 02/2009 09/2005
02/2009 09/2005 02/1998
/ / / / / /
Supervisor/Manager Name Supervisor/Manager Name Supervisor/Manager Name
Darrell Parker Tommy Phillips Tony Leslie
Supervisor/Manager Title Supervisor/Manager Title Supervisor/Manager Title
maintenance manager maint. supervisor General Manager
Address Address Address
2600 Longview St. 140 Shady Brook Lane Hwy 2011 So.
City State/Prov. City State/Prov. City State/Prov.
Kilgore TX Longview TX Longview TX
Country Postal/ZIP Code Country Postal/ZIP Code Country Postal/ZIP Code
USA 75662 USA 75602 USA 75601
Telephone No. Telephone No. Telephone No.
903-***-**** 903-***-**** 903-***-**** Ext. Ext. Ext.
Job Duties Job Duties Job Duties
Inspect, operate, or test machinery to diagnose Repairs to welding equipment, overhead cranes, Repairs to Crome Carbide Machines, welding
malfunctions. Perform Routine Preventive winches, shears, brake press and all shop equipment, plasma cutters[auto & manual] All shop
Maintenance to ensure equipment continues to run equipment.Was acting lead person on 2nd shift. equipment repairs also purchased materials /
smoothly. Repairs to overhead cranes, plasma supplies for plant.
cutters, water jets and machine shop equipment.
Reason for Leaving Reason for Leaving Reason for Leaving
relocated to Pensacola, Fl. Plant having massive layoffs [sought other went to Trinity. [3.25hr more]
Verified Date (MM/DD/YYYY) Verified Date (MM/DD/YYYY) Verified Date (MM/DD/YYYY)
Verified With Verified With Verified With
/ / / / / /
Verified Note Verified Note Verified Note
For additional Hiring Process Kits, order Item 4900.
© 2013 Kelly Services, Inc. Printed in U.S.A. 4901 R6/13
Additional Addresses