Application for Employment 2024 (Newest)

Application for Employment

CFSI, CENTURY LEASING AND CENTURY TEMPORARY *Please note the "SAVE" and "SUBMIT" buttons. If you do not receive a "THANK YOU" page at the end of this application, go to your email and resubmit the application.
WE ARE AN EQUAL OPPORTUNITY EMPLOYMENT COMPANY. WE ARE DEDICATED TO A POLICY OF NON-DISCRIMINATATION ON ANY BASIS, INCLUDING BUT NOT LIMITED TO: RACE, SEX RELIGION, NATIONAL ORIGIN, OR PHYSICAL HANDICAP.
Date*

MonthDayYear
Date
Last Name*
First Name*
Middle Name
Address
House Number and Street Name*
City*
State*
Zip Code*
Phone Number*
Please enter a valid phone number.
Social Security Number*
Have you worked under another name?
Please Upload 1st form of ID*

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Please Upload a selfie of yourself holding the ID next to your face*

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Please Upload a 2nd form of ID

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Vehicle Make and Model
License Plate Number
Type of Employment Desired
Referred By
Date to Start

MonthDayYear
Date
Pay Desired
Are you employed now?*

YesNo
If so, may we contact the employer?
Have you ever applied with CFSI before?*

YesNo
If so, when did you last apply?
Education

Type a question

	Education Type	Name and Location of School	Years Attended	Did you Graduate?	Subjects Studied
1
2
3

U.S. Military Service
Rank
Have you been convicted of a felony within the last five (5) years?*

YesNo
If so, when and what charge?

Employment History

Former Employers: List below 5 employers starting with the latest one first
Upload Resume Here (optional)

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Type a question

	Start Date	End Date	Name and Location of Employer	Pay Rate	Position Held	Reason for Leaving
Job 1
Job 2
Job 3
Job 4
Job 5

Give below names of 2 references not related to you, whom you have known minimum of one year.

	Name	Address	Phone Number	Years Known
Reference 1
Reference 2

I hereby authorize and request any and all of my former employers and other persons, firm or corporation to furnish any and all information concerning my credit worthiness and personal background and I hereby release each such employer or person, firm or corporation, from any and all liability by reason of furnishing the requested information. I understand that in connection with this application, a consumer report and/or an investigative consumer report may be requested whereby information is obtained through personal interviews with my neighbors, friends, or associates or with others with whom I am acquainted to who may have knowledge with respect to my character, general reputation, personal characteristics and mode of living, and hereby authorize the procurement of any such report. I understand that upon my request, I have the right to know if any such report was requested and, if so, the name and address of the consumer reporting agency that furnished such report and in the case of a consumer investigative report, that I may inspect and receive a copy of such report by contacting such agency. I also understand that I have the right to receive a complete and accurate disclosure of the nature and scope of information requested if I request such disclosure within a reasonable period of time.

I understand that if employed: 1) any misrepresentation or omission of facts requested in this application is cause for dismissal; and 2) my employment is for no definite period and I may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.
Signature*

Clear

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegaldiscrimination. For Further Instructions filling out the I-9, please, click the following link. LINK

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.
Other Last Names Used (if any)
Date of Birth*

MonthDayYear
Date
Email Address
example@example.com
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury that I am (choose one of the following boxes):
Citizenship Status*

A citizen of the United StatesA noncitizen national of the United StatesA lawful permanent resident*An alien authorized to work
If you selected "A lawful permanent resident", Enter your *USCIS Number here:
If you selected "A lawful permanent resident" upload the FRONT of your Permanent Resident Card here:

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If you selected "A lawful permanent resident" upload the BACK of your Permanent Resident Card here:

Cancelof
**Expiration Date
I-94 Admission Number (if applicable)
Foreign Passport Number (if applicable)
Signature*

Clear

Read the Following, then Continue
Signature*

Clear

Permission to Perform Background Check

CFSI, Century Leasing, Century Temporary
Previous Address (Address prior to Current)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Read the Following, then Continue
I would like a copy of the consumer report sent to my email address.*

YesNo
Signature*

Clear

Text Notifications

Read, Sign, then Continue
Texting Number
Please enter a valid phone number.
By signing, you have agreed to and understand the "Text Notifications" Policy*

Clear

Safety Rules And Safety Policy Statement

Read, Sign, then Continue
By signing, you have agreed to and understand the "Safety Statement" Policy*

Clear

Check Pick-Up Procedure and Cash Advance Information

Read, Sign, then Continue
By signing, you have agreed to and understand the "Check & Cash Advance" Policies*

Clear

Injury Reporting Procedure

Read, Sign, then Continue
By signing, you have agreed to and understand the "Injury Reporting" Policy*

Clear

Consent Form and CFSI Rules

Read, Sign, then Continue
By signing, you have agreed to and understand the "Consent and CFSI Rules" Policy*

Clear

Medical History
Do you have any restrictions or limitations that would prevent you from doing a certain job? Such as problems standing for long periods of time, lifting heavy objects, or limits in reaching/mobility?*

YesNo
Personal Physician
Physician Address City State Zip Physician's Phone Number
Emergency Contact's Name
Relation
Phone Number
By signing, you have agreed to and understand the "Medical History" Policy*

Clear

Direct Deposit (optional)

Read and Continue

Optional for Bank or Debit Cards

Authorization agreement for direct deposit into your bank of choice. DO NOT fill out if you want to be issued a Wisely Cash Card.
I hereby authorize CFSI Employment Services to initiate credit entries to my account at the depositary institution listed below. (If you have more than two (2) banks please ask for additional forms)
Name of Bank
Bank's Phone Number
Bank Street Address      City   State   Zip

Routing Number
Account Number

Select: Checking Account 1  or Savings Account 2

Choose One of the Following for this Account

	Percentage of Net Pay	Fixed Amount	Remainder of Check
Amount Deposited

Name of Bank #2
Bank #2's Phone Number
Bank #2 Street Address      City   State   Zip

Routing Number
Account Number

Select: Checking Account 1  or Savings Account 2

Choose One of the Following for Account #2

	Percentage of Net Pay	Fixed Amount	Remainder of Check
Amount Deposited

Direct Deposit Verification

To insure the above information is correct, PLEASE, provide a voided check, or confirmation card from your bank that has the routing and account number listed for verification.
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Optional Wisely Cash Card Enrollment Form

This form is for the Wisely Cash Card ONLY. If you have a bank you would like to use for direct deposit, please complete the Bank form. (Wisely Cash Card will be issued along with an account number)
We will need a valid mailing address, especially if your pay card will be mailed to you. Include apartment numbers, lot numbers, unit numbers, etc.
If your mailing address is a PO Box, please, list your physical address:
Physical Address

Physical Address

Apt/Lot/Unit

CityState

Zip Code
TWO FORMS OF IDENTIFICATION MUST BE PROVIDED IN ORDER TO ISSUE PAYCARD.This authority will remain in full force and effect until written notification from me of its termination or change. If an error of under deposit or over deposit is distributed into my account, I authorize Citizens Bank and Trust to make correcting adjustment.

Employee Withholding Certificate (W-4)

Employee’s Withholding Certificate▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.▶ Give Form W-4 to your employer.▶ Your withholding is subject to review by the IRS.For more instructions on filling out the W-4, please visit the following webpage: https://www.irs.gov/forms-pubs/about-form-w-4
Filing Status*

Single or Married filing separatelyMarried filing jointlyHead of Household
Step 2:

Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a)    Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b)    Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c)    If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld.    . ▶

TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

To claim EXEMPT status, check the Instruction LINK above to see if you meet exempt status criteria.
Multiply the number of qualifying children under age 17 by $2,000
Multiply the number of other dependents by $500
Add the amounts above and enter the total here
Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income
Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet and enter the result here
Any extra withholding amount you would like taken per check write amount here.
If you meet the criteria to claim exempt, type "Exempt".

State of Arkansas- Employee Withholding Exemption Certificate (AR4EC)

Instruction's for completing: 1. NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not claim more than the correct number of exemptions. However, if you ex- pect to owe more income tax for the year, you may increase your with- holding by claiming a smaller number of exemptions and/or dependents, or you may enter into an agreement with your employer to have additional amounts withheld. This is especially important if you have more than one employer, or if both husband and wife are employed. 2. DEPENDENTS – To qualify as your dependent (line 1 on the re- verse side), a person must (a) receive more than 1/2 of their support from you for the year, (b) not be claimed as a dependent by such person’s spouse, (c) be a citizen or resident of the United States, and (d) have your home as their principle residence and be a member of your house- hold for the entire year or be related to you as follows: son, daughter, grandchild, stepson, stepdaughter, son-in-law or daughter-in-law; Your father, mother, grandparent, stepfather, stepmother, father-in-law or mother-in-law; Your brother, sister, stepbrother, stepsister, half-brother, half-sister, brother-in-law or sister-in-law; Your uncle, aunt, nephew or niece (but only if related by blood). 3. CHANGES IN EXEMPTIONS OR DEPENDENTS – You may file a new certificate at any time if the number of exemptions or depen- dents INCREASES. You must file a new certificate within 10 days if the number of exemptions or dependents previously claimed by you DE- CREASES for any of the following reasons:(a) Your spouse for whom you have been claiming an exemption is divorced or legally separated, or claims his or her own exemption on a separate certificate, or(b) The support of a dependent for whom you claimed an exemption is expected to be less than half of the total support for the year.OTHER DECREASES in exemptions or dependents, such as the death of a spouse or a dependent, do not affect your withholding until next year, but require the filing of a new certificate by December 1, of the year in which they occur. 4. Claim additional amounts of withholding tax if desired. This will ap- ply most often when you have income other than wages. 5. You qualify for the low income tax rates if your total income from all sources are as shown below:(a) Single $7,800 to $11,400(b) Married filing jointly $15,500 to $16,200(c) Head of Household $12,100 to $16,200 For more information on how to fill out this form, please click on the following link. LINK
Check one of the following for exemptions claimed*

You claim yourselfYou claim yourself and your spouseHead of Household, and you claim yourself
Number of Children or Dependents
Total Number of Dependents
Additional Amount you want Deducted, if any
Do you qualify for low income tax rates?

YesNo
Filing Status*

SingleMarried Filing JointlyHead of Household

Oklahoma Tax Commission- State Withholding Allowance Certificate

This certificate is for income tax withholding purposes only. Type or print. NOTE: Do NOT mail to the Oklahoma Tax Commission. Click the following link to see full instructions for this sheet. LINK
Filing Status*

SingleMarriedMarried, but withhold at higher single rate
Allowance for yourself
Enter 1 for yourself
Allowance for your spouse: Does your spouse work?

YesNo
If yes, enter 0. If no, enter 1 for your spouse
Allowance for Dependents: Enter the number of dependents you will claim on your tax return.
Do not claim yourself or your spouse or dependents that your spouse has already claimed on his or her Form OK-W-4
Do not claim yourself or your spouse or dependents that your spouse has already claimed on his or her Form OK-W-4
Enter the number of additional allowances you would like to claim
Total Number of Allowances You Are Claiming:
Additional Withholding: If you expect to have a balance due (as a result of interest income, dividends, income from a part-time job, etc.) on your tax return, you may request your employer to withhold an additional amount of tax from each pay period. To calculate the amount needed, divide the amount of the expected balance due by the number of pay Periods in a year
Enter the additional amount to be withheld each pay period here
Exempt Status: If you had a right to a refund of all of your Oklahoma income tax withheld last year because you had no tax liability and this year you expect a refund of all Oklahoma income tax withheld because you expect to have no tax liability, write “Exempt” on Line 7
Please check instructions to verify status of exemption
If you meet the conditions set forth under the Service member Civil Relief Act, as amended by the Military Spouses Residency Relief Act and have no Oklahoma tax liability, write “Exempt” on line 8 and complete Form OW-9-MSE.
Please check instructions to verify status of exemption
If income earned as a member of any active duty component of the Armed Forces of the United State is eligible for the military income deduction write “exempt” on Line 9
Please check instructions to verify status of exemption
Should be Empty:

Application for Employment

Address

Education

Employment History

Read the Following, then Continue

Permission to Perform Background Check

Read the Following, then Continue

Text Notifications

Safety Rules And Safety Policy Statement

Check Pick-Up Procedure and Cash Advance Information

Injury Reporting Procedure

Consent Form and CFSI Rules

Medical History

Direct Deposit (optional)

Optional for Bank or Debit Cards

Optional Wisely Cash Card Enrollment Form

If your mailing address is a PO Box, please, list your physical address:

Employee Withholding Certificate (W-4)

State of Arkansas- Employee Withholding Exemption Certificate (AR4EC)

Oklahoma Tax Commission- State Withholding Allowance Certificate