LISDCS_CONSENT_COMBO APPLICANT AUTHORIZATION CONSENT Please Initial All Responses Applicant Name Main Phone Cell Phone Are you at least 18 years of age? Please Initial Yes No Allstaff is a drug free work environment for our clients and employees. With this goal in mind would you be willing to submit to drug screens according to our policies which include Pre-Employment, Random and For Cause testing? Please Initial Yes No Will you authorize Allstaff to examine any and all criminal records and arrests on file in the State of New Hampshire or any other state? Please Initial Yes No Will you authorize Allstaff to examine motor vehicle reports if required by client? Please Initial Yes No If you are applying for a manufacturing position, please select YES below. Check YES to complete the Skill Data Collection Sheet, otherwise check NO. Yes No LIGHT INDUSTRIAL SKILL DATA COLLECTION SHEET Indicate Length of Experience. Leave Blank for No Experience. CONSTRUCTION less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Construction Work less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Carpenter less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Laborer, General less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Landscaper less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Masonry less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Painter less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Plumber less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Roofer less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Snow Removal less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Utility Worker less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years FACTORY/PRODUCTION less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler-Chassis less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler-Electronic less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler-Mechanical less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler-Printed CB less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Assembler-Through H less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Drill Press Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years CNC Programmer less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Factory Worker less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Shop Foreman less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Inspection less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Lathe Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Machine Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Maintenance Worker less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Manager-Distribution less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Manager-Manufacturing less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Manager-QC less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Manager-Safety less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Material Cntrl/Handling less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Mold Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Mold-Injection less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Multi-Access Machines less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Order Picker less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Picking/Packing less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years PCB Rework less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years PCB Assembly less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years PCB Component ID less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Proof Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Production Control less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Production Workers less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Punch Press less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Quality Control (QC) less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years QC Engineer less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years QC Manager less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Schematics less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Soldering less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Soldering-Wave less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Soldering-Post Wave less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Stitcher less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Surface Mount Tech less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Tannery less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Tool & Die less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Welder less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years MISCELLANEOUS less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Auto-body Repair less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Blueprints less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Boiler Attendant less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Clerk-Production Ctr less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Cleaner/Janitor less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Truck Driver less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Generator Repair less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Hazardous Control less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years HVAC less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Lube Technician less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Install Cable less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Parts Person less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Security less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Service Coordinator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Transportation less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Traffic Coordinator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Waste Management less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years TRADE JOURNEYMAN less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years CNC Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Electrician less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Journeyman less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Machinist less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Machine Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Mechanic-Industrial less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Mechanic-Automotive less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Metal Fabrication less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Millwright less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Pipefitter less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Welder less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years WAREHOUSE WORK less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Warehouse Worker less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Shipping less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Receiving less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Material Handling less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Inventory less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Inventory Control less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Packing less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Order Picking less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Loading/Unloading less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Forklift Operator less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years Scheduler less than 1 year 1-3 years 3-5 years 5-7 years 7 plus years You selected that you have experience Loading/Unloading, please indicate the max number of lbs: Additional Skills Comments If you are human, leave this field blank. 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