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?*

YesNo
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?*

YesNo
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?*

YesNo
May we contact your present employer?*

YesNo
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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Date Completed*
Signature*

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Application for Employment