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cebcoadmin
2015-08-31T20:05:47+00:00
Employment Application
NOTICE TO APPLICANTS: This employer is an equal opportunity employer, and will not discriminate against any employee with respect to their compensation, terms, conditions or privileges of employment because of race, color, religion, sex, national origin, marital status, disabilities or any other category protected by any applicable local, state or federal law.
Name
*
First
Middle
Last
Date
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Social Security Number
*
Email
*
Primary Phone Number
*
Other Phone Number
Position Desired
*
Check Type of Employment Desired
*
Full-time
Part-time
Temporary
Seasonal
Check Days Available
*
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Hours Available
*
1st Shift
2nd Shift
3rd Shidt
Willing to work overtime?
*
Yes
No
Geographic Preference
*
Are you legally able to work in the U.S.?
*
Yes
No
Are you 18 Years old?
*
Yes
No
Are you able to perform any or all job functions with or without reasonable accomodation?
*
Yes
No
Have you ever used illegal drugs?
*
Yes
No
Have you used illegal drugs in the last 6 mo?
*
Yes
No
Are you a previous applicant?
*
Yes
No
Have you ever been convicted of a felony or pled nolo contendere to a felony?
*
No
Yes
(conviction will not necessarily disqualify an applicant for employment)
If Yes, describe conditions
Work Experience
NOTE: Start with most recent position, furnish dates and explanation for each period of employment and unemployment for the past 10 years. Attach additional document if needed.
Present / Last Employer
Company Name
Type of Business
Company Address
City
State
Phone
Supervisor Name
Pay Rate
Per hour or per week
Start Date
End Date
Reason for Leaving
Your Job Title
May we contact
Yes
No
Describe responabilities
Company 2
Company Name
Type of Business
Company Address
City
State
Phone
Supervisor Name
Pay Rate
Per hour or per week
Start Date
End Date
Reason for Leaving
Your Job Title
May we contact
Yes
No
Describe responabilities
Company 3
Company Name
Type of Business
Company Address
City
State
Phone
Supervisor Name
Pay Rate
Per hour or per week
Start Date
End Date
Reason for Leaving
Your Job Title
May we contact
Yes
No
Describe responabilities
Company 4
Company Name
Type of Business
Company Address
City
State
Phone
Supervisor Name
Pay Rate
Per hour or per week
Start Date
End Date
Reason for Leaving
Your Job Title
May we contact
Yes
No
Describe responabilities
Company 5
Company Name
Type of Business
Company Address
City
State
Phone
Supervisor Name
Pay Rate
Per hour or per week
Start Date
End Date
Reason for Leaving
Your Job Title
May we contact
Yes
No
Describe responabilities
Education and Training
Please complete all appropriate items.
High School or Trade School
Address
City
State / Province / Region
Degree / Diploma Earned
Yes
No
Major / Minor Fields of Study
Business or Technical School
Address
City
State / Province / Region
Degree / Diploma Earned
Yes
No
Major / Minor Fields of Study
College(s)
Address
City
State / Province / Region
Degree / Diploma Earned
Yes
No
Major / Minor Fields of Study
Other Training (explain)
Address
City
State / Province / Region
Degree / Diploma Earned
Yes
No
Major / Minor Fields of Study
References
List 3 business references (DO NOT LIST RELATIVES OR PERSONAL FRIENDS)
Name
*
Phone
*
Address
*
City
State / Province / Region
Relationship
*
Name
*
Phone
*
Address
*
City
State / Province / Region
Relationship
*
Name
*
Phone
*
Address
*
City
State / Province / Region
Relationship
*
Read Carefully and Sign:
PLEASE READ BEFORE SIGNING: The facts set forth in my application are true and complete. I authorize my former employers to furnish all information pertaining to my work record. I hereby release my former employers from all liability on account of furnishing such information. I understand that if employed, false statements, omissions or misleading statements on the application, regardless of the time they are discovered, shall be considered sufficient cause for dismissal. I also agree that my employer shall not be help liable in any respect if my employment is terminated because of such omissions or false or misleading statements. CEBCO staffing is hereby authorized to investigate my employment history, including contacting employers listed and to verify my education and training.
*
Date
*
Upload Files
Please upload a resume or additional work experience.
Drop files here or
