SSI Application

Brooker Creek Blvd., Suite 325, Oldsmar, FL 34677 tel: 813.855.2131 fax: 813.855.2303

An Equal Opportunity Employer Stansfeld Scott subscribes to the principles of Equal Employment Opportunity. It is our policy to provide equal access to employment for all persons. Those applicants requiring reasonable accommodation to the application and/or interview process should notify a Human Resources representative.

Personal Information

Date

Last Name

First Name

Middle Name

Street Address

City

State

Zip

Daytime Phone

Alternate Phone

Email We'll never share your email with anyone else.

Employer Questions

Position Applied For

Are you legally eligible for employment in this country without sponsorship?

Yes No

How did you learn about our Company?

Date available for work

Desired Annual Salary Range

Type of Employment you are seeking?

Full Time Part Time Temp/Seasonal

Are you willing and able to work overtime if the position requires it?

Yes No Maybe

Are you willing and able to relocate if the position requires it?

Yes No Maybe

Are you willing and able to travel if the position requires it?

Yes No Maybe

Are you willing and able to travel occasionally on weekends if the position requires it?

Yes No Maybe

Have you ever been convicted of a crime or pleaded “guilty” or “no contest” to a crime?

Answering “yes” does not automatically exclude you from further consideration for the position.) If yes, please provide details and date(s):

Do you have a valid driver’s license?

Yes No

State Issue?

Educational Background

School Attended (include city & state) College/University:	Graduate?	Type of Degree	Major	Minor	GPA