ProWorx Staffing — Warehouse & Industrial Worker Application

1

Personal Information

First Name *

Last Name *

Email Address *

Phone Number *

Street Address *

Apt / Unit

City *

State *

ZIP Code *

Date of Birth *

Emergency Contact Name *

Emergency Contact Phone *

Relationship

Reliable Transportation? *

Yes No

2

Position & Certifications

Position(s) Applying For * (select all that apply)

Forklift Operator Warehouse Associate General Laborer Loader / Unloader Order Picker / Packer Inventory / Receiving Industrial Support Production / Assembly

Forklift Certifications (select all that apply)

Sit-Down Counterbalance Stand-Up / Reach Truck Order Picker (Cherry Picker) Pallet Jack (Electric) Pallet Jack (Manual) Clamp / Slip Sheet Turret Truck None

Other Certifications / Licenses

Years of Warehouse / Industrial Experience *

Can you lift 50+ lbs regularly? *

Yes No With Assistance

📎

Required Document Uploads

Please upload a valid government-issued photo ID. Accepted formats: JPG, PNG, PDF. Max 10MB per file.

Driver's License or State ID — Front *

🪪

Click to upload front of ID

JPG, PNG, or PDF · Max 10MB

Driver's License or State ID — Back *

🪪

Click to upload back of ID

JPG, PNG, or PDF · Max 10MB

📋 Accepted IDs

✓ State Driver's License

✓ State ID Card

✓ Must be valid (not expired)

✓ Front & back required

✓ Image must be clear & readable

3

Work Experience

Warehouse / Industrial Systems Experience (select all that apply)

RF / Barcode Scanners WMS (Warehouse Mgmt System) Pick-to-Light / Voice Pick Conveyor Systems SAP / Oracle Inventory Control Shipping / Receiving None

5-Year Employment History * (1 of 5 maximum)

4

Safety & Background

Any workplace injuries or workers' comp claims in the last 3 years? *

Yes No

Any felony or misdemeanor convictions? *

Yes No

Ever terminated or asked to resign? *

Yes No

Failed a drug or alcohol test? *

Yes No

If yes to any above, please explain

5

Availability & Preferences

Available Start Date *

Employment Type Sought *

Desired Pay Rate ($/hr)

Willing to work overtime? *

Yes No Occasionally

Shift Preference

Days (6am–2pm) Evenings (2pm–10pm) Nights (10pm–6am) Weekends Flexible / Any

Preferred Work Location / Region

Additional Notes or Comments

Signature (type your full legal name) *

Date *

By submitting this application, I certify that all information provided is true and complete. I authorize ProWorx Staffing to verify my employment history and references. I understand that false or misleading information may result in disqualification from employment consideration.

Application Submitted!

Warehouse & Industrial
Application Form