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Mon-Thur: 8am-12pm
Sat-Sun: Closed

(434) 385-0061


104 Annjo Court
Suite B
Forest, VA 24551

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Personal Information

General Work Preferences

About Workforce

Legal Questions


Previous Work Experience

Work History (Company 1)

Please begin with your most recent position and answer all questions completely.

Work History (Company 2)

Work History (Company 3)


(Please read the following information carefully.)


I consent to Workforce Solutions seeking and obtaining job-related information concerning my previous employment and education, and I give my consent to my previous employers and educators to provide job-related information concerning my previous employment to Workforce Solutions. I release such persons and organizations from any legal liability for making such statements.

I agree to comply with all Workforce Solutions' policies and requests for information. I agree to submit to job-related examinations, including drug or alcohol tests or screenings, from time to time during the course of my employment whenever requested by Workforce Solutions. The use of, possession of, being under the influence of, or the presence in a person’s system of prohibited drugs and unauthorized alcoholic beverages is prohibited on a Workforce Solutions or client (on-site or off-site) work location.

Any employee incurring a job related injury and/or illness which requires medical attention may be tested for drug/alcohol use. Refusal to take the test or a positive result may result in termination and loss of Worker’s Compensation benefits.

I understand that no statement made to me orally or in writing by Workforce Solutions can create a contract of employment. I also understand and agree that MY EMPLOYMENT IS FOR NO DEFINITE PERIOD OF TIME, and regardless of the date of payment of my wages or salary, IT MAY BE TERMINATED AT ANY TIME BY ME OR Workforce Solutions, WITH OR WITHOUT PRIOR NOTICE. I understand that I am an employee of Workforce Solutions who may be assigned to a client location. I acknowledge that I am an employee of Workforce Solutions and not of Workforce Solutions' client. As such, I am not eligible for client benefit programs. I understand that NO PERSON IS AUTHORIZED TO WAIVE OR CHANGE ANY OF THE TERMS IN THIS FORM.

Workforce Solutions considers applicants for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran's status, the presence of a non-related medical condition or handicap, or any other legally protected status.

By checking the Box below indicates that I have read, understood and consented to the above statements and that I have made true, correct and complete answers on this application and any supplements to it in the knowledge that they will be relied upon in considering my application for employment and I understand that any omission, false answer or statement made by me on this application, or any supplement to it, will be sufficient grounds for my discharge.

Commitment Agreement

(Please read the following information carefully.)


To be considered eligible for employment with Workforce Solutions, you must agree to comply with the following policies and procedures. In addition, if after you are employed by Workforce Solutions you fail to comply with any of the given policies and procedures, disciplinary action up to and including termination will result.

Commitment to Work. I understand that accepting an assignment with Workforce Solutions is a formal commitment to work. I understand that if I accept an assignment from Workforce Solutions, and I fail to show up for work without notifying Workforce Solutions, this is grounds for termination from Workforce Solutions.

  • Arrive On Time. I will arrive on time for each assignment.
  • Wear Appropriate Attire. I will show up in appropriate attire for each assignment.
  • Adhere to Scheduled Lunches and Breaks. I understand that the schedule of lunches and breaks is determined by the client to whom I am assigned and I will adhere to this schedule.

Commitment to Communicate.

  • Show Up or Notify Workforce Solutions In Advance. I understand that if I do not give Workforce Solutions written notice at least one day (24 hours) in advance to let them know that I am unable to complete my assignment, my pay will be reduced to minimum wage for all hours worked in that week's pay period. If one or more of my assignments end at the client's request because of my attendance, my employment with Workforce Solutions may be terminated.
  • Inform Workforce Solutions When Assignment Changes. I will inform Workforce Solutions when my assignment is extended, cancelled, or offered as a direct position.
  • Notify Workforce Solutions When Available For Work. I understand and agree that I must contact/inquire for work with Workforce Solutions for available work upon the conclusion of each work assignment as a condition of my employment. If suitable work assignments are available with Workforce Solutions upon completion of a work assignment, and I fail to inquire about another work assignment, I may not be eligible for unemployment benefits (ORC 4141.29(A)(5)).
  • Call Workforce Solutions Immediately If Injured. I understand that Workforce Solutions is my employer. If I am injured in any way at work, I agree to notify Workforce Solutions immediately.
  • Inform Workforce Solutions of Legal Issues. I agree to notify Workforce Solutions management immediately if I ever am indicted for or convicted of a felony or any crime involving dishonesty or of any workplace substance abuse or drug use, possession or trafficking, during my employment.
  • Alert Workforce Solutions If In Hostile Working Environment. I understand that Workforce Solutions is my employer. I will notify Workforce Solutions immediately if I encounter any behavior that I perceive qualifies as sexual harassment or contributing to a hostile working environment.
  • Immediately report any absence or tardy, or request for time off to Workforce Solutions. I will notify Workforce Solutions of any absence and/or tardy. Any employee failing to report an absence or tardy directly to the Workforce Solutions office, may be considered to have voluntarily resigned from his or her assignment.
  • Workforce Solutions cannot guarantee the ability to hold an assignment open, in the event of an absence(s).

Commitment to Financial Responsibility. I understand that Workforce Solutions may charge me for the costs of any police checks, background checks, vaccinations, and drug tests. I hereby authorize Workforce Solutions to deduct the charge for these services from my paycheck.

Commitment to Confidentiality. - Client Information. I recognize that I may gain access to confidential information while assigned to Workforce Solutions's clients. I agree to treat all client information confidentially.

  • Salary/Wage Information. I will not discuss salary/wage information with anyone except my Workforce Solutions Staffing Solutions representative.

Commitment to Professionalism. I agree to conduct myself in a professional manner at all times while on assignment for Workforce Solutions. I understand that behaving in any lewd or immoral fashion, possessing weapons or explosives, initiating or participating in verbal/physical fighting is prohibited by Workforce Solutions and will result in disciplinary action up to and including termination.

Commitment to Your Employer. I understand that Workforce Solutions is my employer. I will proudly represent the Workforce Solutions name by being an ethical, dependable, and friendly employee.

If you are having any issues filling out this application form, please call us at 434-385-0061 so we can assist you. Thank you.


Contact Us

104 Annjo Court Suite B
Forest, VA 24551-2630

(434) 385-0061


Our Mission

Workforce Solutions is committed to supporting and serving our customers, our contractors and our internal organization. Our commitment to quality and customer service has established us as a preeminent service provider and leader in the industry.