CTH Employment Application

Legal/Medical/Education
Have you ever been convicted of a felony?*

YesNo
If yes, explain, give date & place, and disposition.
Do you have any physical/medical conditions or handicap which may limit your ability to perform the position you applied for?

YesNo
If yes, please explain
Note: We comply with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions
If yes, are you willing to have a health department examination certifying this fact?

YesNo
Level of Education*
Are you currently a student?*

YesNo

Work History

(Current/most recent)
May we contact your current/most recent employer?*

YesNo
Current/most recent employer information:*
Describe your title and the work you did (tasks, responsibilities, projects, etc.) at current/most recent employer*
Start and end date at current/most recent employer*
Reason for leaving

Work History

(If applicable, second most recent)
Second most recent employer information:
Describe your title and the work you did (tasks, responsibilities, projects, etc.) at second most recent employer
Start and end date at second most recent employer
Reason for leaving

Work History

(If applicable, additional information)
Provide any additional information you would like us to consider.
If you would like to share your resume, please upload it here.

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