Employee Application

Please complete all required fields to submit your application.

First Name * Last Name * DOB *

Phone * Email *

Address *

Unit / Apt

I have a Driver's License

DL Number * State

I have been convicted of a felony

I have a Rapid! Pay-card from Synergy

Payment Card:

Select your work authorization type: * SSN:

USCIS Number: Document Number:

I am authorized to work in the U.S. *

SSN Card

FRONT

Government Issued ID

ID Front

ID Back

I agree to the Privacy & Data Usage Policy. *

I acknowledge the Applicant Privacy Notice. *

I consent to electronic records and transactions (E-SIGN/UETA). *

I intend to sign electronically, and my electronic signature is my legal signature. *

Sign Below: