CSS Employment Application

Previous employment

Please use this section to provide information about your previous employment starting with your current or most recent job.
Employment details

CompanySupervisorPhone number (ex: 800-785-4132)EmailJob title
Company Address

Street Address

Street Address Line 2

CityState

Postcode
Date Started
Date Ended
Responsibilities
Reason for leaving (be specific)
Employment details

CompanySupervisorPhone number (ex: 800-785-4132)EmailJob title
Company Address

Street Address

Street Address Line 2

CityState

Postcode
Date Started
Date Ended
Responsibilities
Reason for leaving

Education

Please use this section to provide information about your previous education including the qualifications/certificates your have gained.
High School

Name of High SchoolYear CompletedDid you receive a diploma or GED?
Address

Street Address

Street Address Line 2

CityState

Postcode
College/University

School nameYear CompletedType of Degree ObtainedHow many years completed?Major or Specialization
Address

Street Address

Street Address Line 2

CityState

Postcode
Other/Trade School/Program

School or Program NameSpecializationYear CompletedType of Degree or CertificationHow many years completed?
Address

Street Address

Street Address Line 2

CityState

Postcode

References

Please list below 3 persons (not related to you) who have knowledge of your work performance and/or personal qualifications within the last 5 years
Reference 1

Full nameRelationshipPhone numberCompany
Address
Reference 2

Full nameRelationshipPhone numberCompany
Address
Reference 3

Full nameRelationshipPhone numberCompany
Address

Criminal Background History

Due to the nature of employment with this agency, all potential employees are required to undergo a Live Scan background check through the Department of Justice (DOJ) and/or the Department of Developmental Services (DDS).
The following questions are for pre-screening purposes and is not the background check in and of itself. Answering yes to any of the following questions does not necessarily disqualify a candidate from employment
Have you ever been convicted of a crime other than a minor traffic violation?
If yes, briefly explain the number of conviction(s), nature of offense(s), how recently such offense(s) was/were committed, sentence imposed, etc
Have you been convicted of a DUI?
If yes, briefly explain the number of conviction(s), nature of offense(s), how recently such offense(s) was/were committed, sentence imposed, etc

Are you currently employed?
May we contact your present employer?
Did anyone refer you to this company?
If yes, please provide their names and relationship to you
Please submit your resume

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Application for Employment