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First name

Last name

Phone number

Email*

City

State/Region

Date of birth

Are you at least 18 years old?

Yes

No

Are you legally authorized to work in the US?

Yes

No

Are You a Veteran?

Yes

No

Do you have a valid drivers license?

Yes

No

Have you ever been convicted of a crime?

Yes

No

If Yes, Explain

Desired Position?

If other, list other desired position

Full Time or Part Time?

Yes

No

How Far Are You Willing To Travel?

Shift Preference

Desired Hourly Rate

How soon can you start?

Please List Your Skills

Have you spoken with a recruiter?

Yes

No

If you would like to send a resume along with your application, please email a copy of your resume to jobs@roebuckstaffing.com with your name as the Subject of the email.