Registration Page

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Please fill out the form below to submit your registration. If you prefer to print and fill out a paper registration to drop off at our office, CLICK HERE.

If you already registered with Coryer Staffing? CLICK HERE

General Information

Already Registered with Coryer Staffing? Registered candidates need only provide name, email, and phone number.YesNo

Do you have a Coryer Staffing recruiter you would like to reference?

First Name

Last Name

Nick Name (ex. "Bill" if you are William)

Email Address

Cell/Mobile Phone

Home Phone

Work Phone

Street Address

City

State

Zip

How would you like to be contacted?When is the best time to contact you?Are you a US citizen?YesNoAs a condition of employment with Coryer Staffing Corporation, successful applicants must provide, within three (3) days after employment begins, documentation to prove identity and proper authorization to work in the United States.

Education Level

Primary Experience Category

Availability

Employment StatusI am currently employedI am not currently employedWhen are you available to begin work?

When can you work? (check all that apply)

First Shift (daytime)

Second Shift (evenings)

Third Shift (overnight)

Full Time

Part Time

Seasonal

Are you willing to fill temporary work assignments?YesNoAre you able to work rotating shifts?YesNoAre you able to work overtime as required?YesNoPreferred CompaniesREAD THE FOLLOWING STATEMENTS CAREFULLY. Place a checkmark under “Yes”next to each statement that is true and place a checkmark under “No” next to eachstatement that is false. These responses will only be used if they relate specifically toyour fitness to perform a particular position.

Yes

I have been convicted of a crime. If yes, please explain and provide dates:

Yes

I have been known by another name(s). If yes, what other name(s):

Yes

I am under the age of 18.

Yes

I am willing to undergo pre-employment or random drug screening.

Yes

I do possess a valid driver’s license and/or reliable transportation.

Yes

I do possess a CDL or other license that enables me to drive a tractor trailer.
If yes, what is the class of the license and the endorsements:

Are you currently interviewing for any other positions?Where else have you applied?

Work History

Please attach a resume or fill out this section

Company 1

Company Name & Location

most recent or current job

Job Title

Rate of Pay

enter approximate whole number, without commas

Start Date

End Date

Last Manager Name

Phone

May we contact?YesNo

Reason for leavingBrief description of duties

References

List two or more references, preferably past supervisors or professional persons other than relatives. If you have listed supervisors that we may contact in the Employment History section, you may include enough contacts here to bring the total to two.

REference 1

First Name

Last Name

Years Known

Company Name

Title

Phone

Education

High School

Name of School

Location

Did you graduate: YesNo

College

Name of School

Location

Subjects or Major

Degree

Other Education

Name of School

Location

Subjects or Major

Degree

Other Professional TrainingCertifications Received:

Resume Upload: If you have a prepared resume, you can upload it here.

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General Candidate CommentsIMPORTANT! CHECK THIS BOX if you agree that by submitting this form I permit Coryer Staffing to use my information to place me in a job.

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Registration Page

General Information

Availability

Work History

Company 1

Company 2

Company 3

References

REference 1

Reference 2

Reference 3

Education

High School

College

Other Education