This document is an application for employment that collects personal and professional details from the applicant. It requests information such as contact details, eligibility to work, availability, criminal history, skills and experience, education history, employment history, references, and availability for overtime work or restrictions on availability. The applicant is applying for an unspecified position at Addison Recruiter.

1. Application for Employment
APPLICATION DATE: ______/______/______ Addison Recruiter _______________________
Social Security #: ________/_____/_______ Email: ____________________________________
Last Name: _________________________ First Name: _____________________ Middle: ________
Address: __________________________________________________________
City: ___________________ State: ___________ Zip: ____________
Home #:_____________________ Work #: __________________ Cell Phone #: __________________
Personal URL: _________________________________
Have you worked as a temporary /contract employee? Yes No
Name of Staffing Dates Companies Supervisor’s Title Salary
Firm worked for Name
Pay per hour: Minimum $________ Most Recent $_______
Pay per year: Minimum $________ Most Recent $_______
Are you legally eligible for employment in this country? Yes No
Date Available for Work: ____________________ Will you work over-time if required? Yes No
Are there any days/times you are not available? ______________________________________________
Have you ever pled “guilty” or “no contest” to, or been convicted of a crime? Yes No
If yes, please provide date(s) and details:
ANSWERING “YES” TO THESE QUESTIONS DOES NOT CONSTITUTE AN AUTOMATIC BAR TO EMPLOYMENT. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF
THE VIOLATION, REHABILATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
ADDISON SEARCH ADMINISTRATIVE IS AN EQUAL OPPORTUNITY EMPLOYER
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 1
Phone: 312-425-0200 - Fax: 312-425-0210

2. JOB CODE:
(Recruiter’s Use Only)
Skills and Experience
Please circle the areas in which you have experience:
Software Industries
Access Advertising Law Firm
ACT! Agency Leasing
Acrobat Architect Manufacturing
ADP Biotech Marketing
Dreamweaver Banking Mutual Fund
Excel Brokerage Non-Profit
File Maker Pro Broadcasting Oil & Gas
Illustrator Collection Agency Pharmaceutical
InDesign Consulting Non-CPA Property Management
Lotus Notes Construction Publishing
MAC Delivery Public Relations
Outlook Distribution Real Estate
PageMaker E-Commerce Retail
PeopleSoft Education Retirement
Photoshop Energy Service Misc
PowerPoint Engineering Software
Publisher Entertainment Trading
Quark Environmental Travel
QuickBooks Financial Service Utility
Quicken Food Service Venture Capital
Word Government Waste Disposal
WordPerfect Healthcare Wholesaler
Hospitality
Import/Export
Insurance
Investment
Area Desired:
LOOP CITY NORTH CITY SOUTH CITY WEST N. SUBURBS S. SUBURBS W. SUBURBS
Do you have access to a car? YES NO Languages Spoken:
Type of Employment Desired: Direct Hire Temporary Temp-to-hire ALL
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 2
Phone: 312-425-0200 - Fax: 312-425-0210

3. Educational Background
Starting with your most recent school attended, provide the following information:
School (Include City and State) Years Degree Earned Graduation Date
Completed
Employment History
Starting with your most recent employer, assignments or volunteer activities provide the following information:
Employer: ___________________________________ Job Title: ________________________________________
Address: _______________________________________________________________________________________
Immediate Supervisor: ___________________________ Phone Number: _____________________________
Dates Employed: From ________/________ to ________/________ Salary___________________________
Reason for Leaving: _____________________________________ Call for Reference Yes No
Employer: ___________________________________ Job Title: ________________________________________
Address: _______________________________________________________________________________________
Immediate Supervisor: ___________________________ Phone Number: _____________________________
Dates Employed: From ________/________ to ________/________ Salary___________________________
Reason for Leaving: _____________________________________ Call for Reference Yes No
Employer: ___________________________________ Job Title: ________________________________________
Address: _______________________________________________________________________________________
Immediate Supervisor: ___________________________ Phone Number: _____________________________
Dates Employed: From ________/________ to ________/________ Salary___________________________
Reason for Leaving: _____________________________________ : Call for Reference Yes No
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 3
Phone: 312-425-0200 - Fax: 312-425-0210

4. Professional References
To complete our registration process, and assist us in your employment search, please list as many
professional references as possible (Including Direct Supervisors, Indirect Supervisors, Co-Workers and
Subordinates). Attach additional sheets as necessary.
Where did you What company Current May we
work with this Title do they work for
Name Relationship now? Telephone Call?
person?
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Direct Supervisor
Indirect Supervisor
Co-Worker Y N
Subordinate
Peer References
List the name and telephone number of peer references.
Name Title Relationship to Candidate Telephone Years Known
How did you hear about us? Referred by ____________________________
Craig’s List Walk-in Web-Site Monster CareerBuilder Cold Call Linked In Other
Emergency Contact Name: __________________ Phone #:_______________ Relationship__________
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 4
Phone: 312-425-0200 - Fax: 312-425-0210

5. RECRUITER USE ONLY:
Current Job Title ___________________________________
Interview Summary: _____________________________________________________________________
Interview Notes:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Word Excel PowerPoint ACCESS Outlook
Overall _____ _____ _____ ______ _____
Basic _____ _____ _____ ______ _____
Intermediate _____ _____ _____ ______ _____
Advanced _____ _____ _____ ______ _____
Typing __________ Data Entry __________
Actor Human Resources
Admin/Receptionist Inside Sales
Accounts Payable Law Clerk
Accounts Receivable Legal Secretary
Accounting Assistant Litigation Support
Administrative Assistant Mailroom
Benefits Marketing
Call Center Market Research
Clerk NORC
CODER- NORC Office Manager
Customer Service Paralegal
Data Entry Prompter- NORC
Editors Public Relations
Event Planner Reception
Executive Assistant Recruiter
Facilities Manager Registration
Fresh Grad Sales Assistant
Graphics Word Processor
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 5
Phone: 312-425-0200 - Fax: 312-425-0210

6. Background Investigation Consent Form
I, _________________________, hereby authorize Addison Search Inc. and/or its agents to make an independent
investigation of my background, references, character, past employment, education, and any other relevant information
for the purpose of confirming the information contained on my application and/or obtaining other information which
may be material to my qualifications for employment.
I release from liability and hold harmless Addison Search Inc., my previous employers, and any other third parties who
provide information pursuant to this authorization, along with their respective officers, directors, employees, and
agents.
The following is my true and complete legal name, and all information is true and correct to the best of my knowledge:
Full Name (Printed) SSN - -
Maiden Name or Other Names Used
Please list every address of residence for the last 7 years
Present Address
City State Zip Code
How long have you lived at this address?
Past Address
City State Zip Code
How long have you lived at this address?
Past Address
City State Zip Code
How long have you lived at this address?
Applicant Signature Date / /
Note: A copy of this signed Consent Form shall be as effective as the original.
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 6
Phone: 312-425-0200 - Fax: 312-425-0210

7. Application for Employment for Addison Search Administrative
I certify that all information I have provided in order to apply for and secure work with Addison Search
Administrative is true, complete and correct.
I expressly authorize, without reservation, Addison Search Administrative, its representatives, employees or
agents to contact and obtain information from all references (personal and professional), employers, public
agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all
information provided by me in this application, resume or job interview.
I herby waive all rights and claims I may have regarding Addison Search Administrative, its agents,
employees or representatives, for seeking, gathering and using such information in the employment process
and all other persons, corporations or organizations for furnishing such information about me.
I hereby authorize Addison Search Administrative and/or its agents to make an independent investigation of
my background and credit history.
I understand that Addison Search Administrative does not unlawfully discriminate in employment and no
question on this application is used for the purpose of limiting or excusing any applicant from consideration
for employment on a basis prohibited by applicable local, state or federal law.
I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work
in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
I hereby agree that I have been notified of all policies and procedures required for successful employment
with Addison Search Administrative. I further testify that I fully understand and agree to these policies and
the terms of my employment with Addison Search Administrative.
Also, by signing below, I acknowledge that I have been notified that failure to contact Addison Search
Administrative within 48 hours after the end of my assignment and once per week thereafter, may affect my
eligibility for unemployment insurance.
I understand that any information provided by me that is found to be false, incomplete or
misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this
application, or (ii) immediately discharge me from the employer’s service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT:
I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
Signature of Applicant________________________________________ Date: ________________
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 7
Phone: 312-425-0200 - Fax: 312-425-0210

8. Addison Search Employment Agreement (Candidate Copy)
Welcome to Addison Search Administrative. We look forward to assisting you in your current job search.
The following is a list of policies and procedures required by all Addison Search employees who contract/temp at an Addison
Search client:
WHEN TO CALL YOUR RECRUITER:
*When you are unable to make it in to your job for ANY reason. Leave a message on our general voicemail box if you cannot
reach anyone.
*When you are running late or have to leave your assignment early.
*When you arrive at your assignment on your 1st day.
*When you are unable to complete the job to which you have been assigned (See “Notice” Below)
*When you are offered permanent employment at the assignment.
*When you need to talk about any problems related to your present assignment.
*When you want to refer friends or co-workers to us so you may receive your referral bonus.
NOT ACCEPTABLE:
*Using the company phone for personal calls
*Using cellular phones and/or having them turned on while at the client site.
*Having pagers activated while at the client site.
DRESS ATTIRE:
Each company has their own dress code policy. Please ask your recruiter what the appropriate attire is for each assignment prior to
starting an assignment.
BREAKS:
Lunch breaks and regular breaks are to be determined by the manager of the assignment. You should follow the guidelines of the
company where you are working.
TIMECARDS:
*Timecards are due by Noon each Monday in order to be paid for the week. FAX copies are acceptable for the purpose of
reporting hours.
All checks will be sent out Wednesday evening.
*Direct Deposit is also available for your convenience. You must fill out a form that will be submitted with the payroll.
NOTICE:
In order to maintain the high level of professionalism that Addison Search’s clients have come to expect, we require a MINIMUM
1 week notice be given when leaving a contract/temp assignment. In order to recoup the cost of replacing the assignment and the
cost of any training credits given to the client, Addison Search reserves the right to pay any hours worked in your final week at the
minimum hourly rate allowable by law. This will take effect only in the event that the minimum 1-week notice is NOT given. We
wish you the best of luck in your current job search. All of us at Addison Search pledge to do whatever we can to assist you in
furthering your career.
I hereby agree to the policies set forth in this agreement.
___________________________ ______________________________
Signature Addison Search Representative
____________________________ ________________
Printed Name Date
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 8
Phone: 312-425-0200 - Fax: 312-425-0210

9. Addison Search Employment Agreement (Recruiter Copy)
Welcome to Addison Search Administrative. We look forward to assisting you in your current job search.
The following is a list of policies and procedures required by all Addison Search employees who contract/temp at an Addison
Search client:
WHEN TO CALL YOUR RECRUITER:
*When you are unable to make it in to your job for ANY reason. Leave a message on our general voicemail box if you cannot
reach anyone.
*When you are running late or have to leave your assignment early.
*When you arrive at your assignment on your 1st day.
*When you are unable to complete the job to which you have been assigned (See “Notice” Below)
*When you are offered permanent employment at the assignment.
*When you need to talk about any problems related to your present assignment.
*When you want to refer friends or co-workers to us so you may receive your referral bonus.
NOT ACCEPTABLE:
*Using the company phone for personal calls
*Using cellular phones and/or having them turned on while at the client site.
*Having pagers activated while at the client site.
DRESS ATTIRE:
Each company has their own dress code policy. Please ask your recruiter what the appropriate attire is for each assignment prior to
starting an assignment.
BREAKS:
Lunch breaks and regular breaks are to be determined by the manager of the assignment. You should follow the guidelines of the
company where you are working.
TIMECARDS:
*Timecards are due by Noon each Monday in order to be paid for the week. FAX copies are acceptable for the purpose of
reporting hours.
All checks will be sent out Wednesday evening.
*Direct Deposit is also available for your convenience. You must fill out a form that will be submitted with the payroll.
NOTICE:
In order to maintain the high level of professionalism that Addison Search’s clients have come to expect, we require a MINIMUM
1 week notice be given when leaving a contract/temp assignment. In order to recoup the cost of replacing the assignment and the
cost of any training credits given to the client, Addison Search reserves the right to pay any hours worked in your final week at the
minimum hourly rate allowable by law. This will take effect only in the event that the minimum 1-week notice is NOT given. We
wish you the best of luck in your current job search. All of us at Addison Search pledge to do whatever we can to assist you in
furthering your career.
I hereby agree to the policies set forth in this agreement.
___________________________ ______________________________
Signature Addison Search Representative
____________________________ ________________
Printed Name Date
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 9
Phone: 312-425-0200 - Fax: 312-425-0210

10. Addison Search contract employees are eligible for the following benefits:
HEALTH INSURANCE
All Addison Search contract employees shall be eligible for medical and dental benefits once he/she has worked a total of
720 hours. The qualifying employee will be eligible to enroll for health and/or dental insurance coverage immediately
following the qualification period and coinciding with the next immediate enrollment cycle. Addison Search shall
contribute per week towards an employee’s medical health insurance; employees are responsible for any costs over this
amount.. A fee schedule for extra coverage may be found below. Employees with domestic partners are able to enroll
him/her as a spouse; when enrolling with this option, please contact Human Resources for a Domestic Partner form.
Blue Cross Medical Insurance
cost per week to employee:
Benefits
HMO PPO Select PPO
Single subscriber (Addison Employee) $6.55 $13.55 $20.62
Employee + Spouse/
$86.03 $101.51 $117.13
Domestic Partner
Employee + 1 Child $81.68 $96.69 $111.85
Employee + 2 or more Dependants $161.15 $184.05 $208.37
Guardian Dental Insurance
cost per week to employee:
Benefits
DMO PPO/Value Plan
Single subscriber (Addison Employee) $3.79 $8.90
Employee + 1 Dependent $7.19 $17.09
Employee + 2 or more Dependants $11.10 $26.07
***Employees outside of the state of Illinois are not eligible to enroll in the Blue Cross HMO or PPO
Select plans, or the Guardian DMO plan.
All Addison Search employees health insurance is only effective
through the Sunday following their final day of work.
COBRA information will be sent to the employee as soon as their end date is processed.
LTD AND LIFE INSURANCE
Long Term Disability and Life insurance are available on a voluntary basis to Addison Search employees through
Guardian. Coverage is based on an employee’s chosen benefit rates, annual compensation, and willingness to participate.
Coverage is portable and employees may choose to discontinue participation at any time.
Enrollment periods are concurrent with health insurance enrollment; employees are eligible to enroll effective the first of
the month after the employee has worked a total of 720 hours.
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 10
Phone: 312-425-0200 - Fax: 312-425-0210

11. 401K
All Addison Search employees over the age of 21 shall be eligible for 401k benefits after one year of employment.
Enrollment periods are the first check date of each quarter.
Employees may contribute up to 50% of their income to Addison Search’s 401(k) plan, not to exceed $15,500 in one
calendar year (subject to change, depending on federal allowances). Addison Search will match at 100% the first 3% of
the employee’s contribution, and will match at 50% the next 2% of the employee’s contribution.
Please mail all enrollment forms back to Meredith Conner
at the following address:
Addison Search, LLC
222 S Riverside Plaza Suite 1710
Chicago, IL 60606
222 S. Riverside Plaza Ste 1710 Chicago, IL 60606 11
Phone: 312-425-0200 - Fax: 312-425-0210