Employment Application

Thank you for expressing interest in employment with one of the CAS INDUSTRIES family of companies. Please complete this form and present to the hiring manager of the location you desire to work. Once your information is reviewed, which may include a check of your motor vehicle record, an offer of employment may be extended to you. The competition of this form is NOT an offer of employment or an employment contract.

Company Applying For:

Position Applied for

Desired Schedule:

Full TimePart TimeSeasonal

Name

First NameLast Name

M.I.

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone

Email Address

example@example.com

Date Available

Date

Social Security No.

Desired Salary

Are you a citizen of the United States?

YESNO

If no, are you authorized to work in the U.S.?

YESNO

Have you ever worked for this company?

YESNO

If so, when?

Have you ever been convicted of a felony?

YESNO

If yes, explain

High School

Address

From

Date

To

Date

Did you graduate?

YESNO

Degree Study

College/Trade

Address

From

Date

To

Date

Did you graduate?

YESNO

Degree Study

Other

Address

From

Date

To

Date

Did you graduate?

YESNO

Degree Study

Please list three professional references.

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Full Name

Relationship

Company

Phone

Address

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Date

To

Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Company

Phone

Address

Supervisor

Job Title

Ending Salary

Responsibilities

From

Date

To

Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From

Date

To

Date

Reason for Leaving

May we contact your previous supervisor for a reference?

YESNO

Branch

From

Date

To

Date

Rank at Discharge

Type of Discharge

If other than honorable, explain

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Date

CAS INDUSTRIES

APPLICANT INFORMATION

EDUCATION

REFERENCES

PREVIOUS EMPLOYMENT

MILITARY SERVICE

DISCLAIMER AND SIGNATURE