The Opportunity
The Plan
The Bottom Line
F.A.Q.
The Five Steps
The Agreement
RD Application
Contact Info
616 N. CAUSEWAY BLVD.
METAIRIE, LA 70001
504 779-9040
1-866-871-0097 FAX
The completion of these application forms does not obligate the Applicant nor WORKNET to enter into any type of agreement for the purpose of providing temporary employment services.
GENERAL INSTRUCTIONS
Complete each form to fullest extent possible
Follow any special instructions noted on the forms
Instead of leaving an item blank, mark it "NA"
Sign and date the Authorization form
If you have any questions, call Adam Bermudez at 1-800-299-8367
CONFIDENTIAL PERSONAL PROFILE
DATE
NAME
LAST
FIRST
MIDDLE
SOCIAL SECURITY NUMBER
DATE OF BIRTH
BIRTHPLACE (City/Court/State)
PRESENT ADDRESS
TELEPHONE
CITY AND STATE
ZIP
HOW LONG?
EDUCATIONAL BACKGROUND
SCHOOL AND LOCATION
MAJOR
DEGREE
YEAR
PERSONAL REFERENCES
NAME
COMPANY/POSITION
RELATIONSHIP
PHONE
KNOWN HOW LONG?
BUSINESS EXPERIENCE PROFILE
EMPLOYMENT HISTORY
DATES OF
EMPLOYMENT
COMPANY
NAME
COMPANY
LOCATION
SUPERVISOR
PHONE
NUMBER
LAST TITLE/
POSITION HELD
LAST
SALARY
PERSONAL REFERENCES
BANK NAME
ACCOUNT OR
LOAN NUMBER
BANK OFFICERS NAME
PHONE NUMBER
ACCOUNT OPENED OR
LOAN DATE
How much are you prepared to invest in a new business? $
/month
Do you plan to have a business or financial partner in this operation?
If
yes
, please list all names and addresses below and describe each person's involvement.
NAME
ADDRESS
INVOLVEMENT
List amounts of financial assets that you have available to finance your business.
Monthly Income
Savings
Life Insurance
Stocks/Bonds
Real Estates
Other
List amounts of all your current financial liabilities.
List amounts of all your current financial liabilities.
House Mortgage
Car Note(s)
Personal Loans
Property Liens
Legal Judgements
Other
Have you ever declared bankruptcy
If yes, please explain the circumstances.
BUSINESS OWNERSHIP INFORMATION
This form is to be completed by applicants who currently own and operate a business.
Company Name
Phone
Company Address
City
State
Zip
Business Activity:
Type:
Corporation
Partnership
Proprietorship
Federal ID#:
State of Incorporation
Date of Incorporation
DUNS #
BANK REFERENCES
BANK NAME/LOCATION
BANK OFFICER
PHONE
ACCOUNT TYPE/NUMBER
FINANCIAL INFORMATION
ACCOUNTS/BALANCE
CURRENT YEAR
PREVIOUS YEAR
REVENUES
CURRENT ASSETS
LONG-TERM ASSETS
CURRENT LIABILITIES
LONG TERM LIABILITIES
OWNERS EQUITY
How does a WORKNET Regional Directorship fit with the operations of this business:
PREVIOUS TEMPORARY INDUSTRY EXPERIENCE
This section is to be completed by applicants who have had previous temporary industry experience.
Company Name
Phone
Company Address
City
State
Zip
Your Title
Supervisor
Number of Years
Describe Your Duties
AUTHORIZATION
The completion of these forms and this Authorization does not obligate Worknet or the undersigned to enter into any type of Work Agreement for the purpose of providing temporary employee services. The undersigned certifies that all the informantion provided is accurate and complete.
The undersigned hereby authorizes Worknet uits agent, or representative, to make any investigation of the undersigned's personal or employment history. Furthermore, the undersigned hereby authorizes any former employer, person, firm, corporation, school, credit agency or government to give Worknet any information they may have regarding the undersigned. The undersigned understands that this investigation may inquire into the undersigned's background, personal reputation, life style, character, "standing in the community", credit worthiness, and financial condition. The undersigned hereby releases Worknet and all providers of information from any liability as a result of receiving or furnishing any information. This authorization shall be valid for this investigation in original or copy form.
Signature
Date
Signature
Date
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Worknet 2000, Inc.
616 N. CAUSEWAY BLVD.
