CCS Group Application

CCS Headquarters
655 South Street, Suite #2
Seward, NE 68434
(855) 752-5047 – Phone
(402) 643-0143 – Fax

Please read employment application instructions before completing this form

Upload Your Resume

Position For Which You Are Applying:

Check all that you may be interested in:

Full-TimePart-TimeSeasonal

Name*

First NameMiddle InitialLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Do you have a valid drivers license?*

YesNo

Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and reason.*

If hired, are you authorized to work in the United States? For non citizens, a copy of your authorization to work issued by the U.S. Immigration and Naturalization Service must be submitted prior to appointment.

Please Give the Name and Phone Number of 4 References:

Elementary and High School Education

Highest Grade Completed

Did you graduate from High School or obtain a GED?*

YesNo

Name and Location of Last School Attended:

Secondary Education

Years Completed

Did you obtain a degree?

YesNo

Name and Location of Last School Attended:

Job 1

May we contact your present/past employer?*

YesNo

Starting Date month/day/year*

Date

Ending Date month/day/year*

Date

Employer/Company Name and Address (city and state are required)*

Hours per Week*

Name & Title of Immediate Supervisor*

Company Phone Number*

Reason for Leaving*

Rate of Pay When Left*

Title of Position Held*

Number & Job Title of Employees you Supervised*

Describe job responsibilities in order of importance:*

Job 2

Starting Date month/day/year*

Date

Ending Date month/day/year*

Date

Employer/Company Name and Address (city and state are required)*

Hours per Week*

Name & Title of Immediate Supervisor*

Company Phone Number*

Reason for Leaving*

Rate of Pay When Left*

Title of Position Held*

Number & Job Title of Employees you Supervised*

Describe job responsibilities in order of importance:*

Job 3

Starting Date month/day/year*

Date

Ending Date month/day/year*

Date

Employer/Company Name and Address (city and state are required)*

Hours per Week*

Name & Title of Immediate Supervisor*

Company Phone Number *

Reason for Leaving*

Rate of Pay When Left*

Title of Position Held*

Number & Job Title of Employees you Supervised*

Describe job responsibilities in order of importance:*

CONDITIONS OF EMPLOYMENT STATEMENT

Under penalties of perjury, declare that my answers to the questions on this application and any necessary examinations and supplements are true andgive CCS Group, LLC the right to investigate all information given and to secure additional appropriate information if necessary. I understand that an investigative report may be made from information obtained through personal interviews with others. I understand that this inquiry may include information as to my personal characteristics, employment verification, credential verification, personal identity verifications, reference checks,criminal records, motor vehicle records, and appropriateness for employment. In accordance with the law and my understanding of this statement, I authorize my current and former employers to give any information regarding my employment, together with all information regarding me, and hereby release from all liability or responsibility all persons, companies, or corporations furnishing such information in good faith.

I understand that the completion of this application does not assure me of a position with CCS Group, LLC and does not obligate CCS to me in any way. I further understand that any misrepresentation herein may cause my application to be rejected, my name to be removed from the eligible register and/or subject me to dismissal. Candidates selected for hire must pass a physical and drug screen prior to employment. I am aware that the results will be made available to the Human Resources Director or a duly authorized representative. CCS Group, LLC is committed to a drug free work place to protect the safety of workers and the public and will comply with the Federal Drug Free Work Place Act.

I understand that this application, exam documents and attachments become a part of CCS Group, LLC records and will not be returned, reused or copied for me once submitted. - am also aware that my application is subject to the Nebraska open records law and may be released as a public document.

*All new hires must complete a Urinary Analysis PRIOR to starting work with CCS. If the initial analysis comes back positive or inconclusive, you will be responsible for a second test which may be done at the local medical clinic.

By my signature, I certify, authorize and acknowledge the above statements.

Date*

Date

Signature *

Phone Number*

We continually review applications for potential team members with talent, initiative, and drive to help our company achieve new levels of excellence. If you're a motivated individual looking for an exceptional opportunity with a company that offers training, competitive wages, promotes equal employment opportunities and a safe work environment, CCS Group, LLC may be the place for you.

If you have any questions, please contact: sarah@ccsgrouponline.com

Employment Application

REFERENCES

EDUCATION AND TRAINING

EMPLOYMENT HISTORY STARTING FROM MOST RECENT