Application For Employment 2025

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
Enter Todays Date
NAME:
FIRST*
MIDDLE
LAST*
ADDRESS:
HOUSE NUMBER AND STREET NAME*
CITY*
STATE*
State Abbreviation
ZIPCODE*
PHONE NUMBER*
Please enter a valid phone number
SOCIAL SECURITY NUMBER*
HAVE YOU WORKED UNDER ANOTHER NAME?
PLEASE UPLOAD A FIRST FORM OF IDENTIFICATION

Ex: Drivers License, State ID, Passport, Permanent Resident Card, etc.
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PLEASE UPLOAD A SECOND FORM OF IDENTIFICATION

EX: SSC, Birth Certificate, Tribal card, etc.
Cancelof
VEHICLE MAKE/MODEL
LICENSE PLATE NO
EMPLOYMENT DESIRED
REFFERED BY
DATE TO START

MonthDayYear
Date you're available to start work
PAY DESIRED
ARE YOU EMPLOYED CURRENTLY?*

YESNO
IF SO, MAY WE CONTACT THE EMPLOYER?
Yes or No
HAVE YOU EVER APPLIED TO CFSI BEFORE?*

YESNO
IF SO, WHEN DID YOU APPLY?
US MILITARY SERVICE
RANK
HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST (5) YEARS?*

YesNo
IF SO, WHEN AND WHAT CHARGE?

EDUCATION INFORMATION

Education:

	Education Type	Name/Location of school	Years Attended	Graduated? Y/N	Subjects
1
2
3

EMPLOYMENT HISTORY :

List five previous employers below. Start with the most recent first. Or - Upload a current Resume.
Upload a resume

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

Give below names of two references not related to you, whom you have known a 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)
Email address*
Example@gmail.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:
USCIS Number
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 (if applicable)
Expiration of permanent resident card if applicable
I-94 Admission number (if applicable)
Foreign Passport Number (If applicable)
Date*

MonthDayYear
Todays Date
Signature*

Clear

Read the following, then continue
Signature*

Clear

PERMISSION TO PERFORM BACKGROUND CHECK

CFSI, CENTURY LEASING, CENTURY TEMPORARY
Name*

First NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Birthdate
Social Security*
Previous address (Address prior to your current address)

Previous Address

Street Address Line 2

CityState

Zip
Email*
example@example.com
I would like a copy of the consumer report sent to my email address*

YesNo
Applicant Signature*

Clear

TEXT NOTIFICATIONS

Read, Sign, Then Continue
Phone Number
Valid phone number with texting capability
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
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? (We ask to ensure we don't place you in a work environment that may aggravate previous health issues or injuries)*

YesNo
PHYSICIANS INFORMATION

Physicians Name

Physicians Address

CityState / Province

Physicians Phone Number
EMERGENCY CONTACT INFORMATION
Name
Relation
Phone Number
By signing, you have agreed to and understand the "Medical History" Policy*

Clear

Direct Deposit

Read and Continue.

Direct Deposit Form (OPTIONAL)

Do not fill out this form if you wish to have a wisely cash card or paper checks.
I hereby authorize C.F.S.I. Employment Services to initiate credit entries to my account at the depositary institution listed below (If you have more than two banks please ask for additional forms)
Please enter your information: Employee Name Social Security Number Employee Street Address City State Zip Phone Number

Banking Information

	Name of bank #1	Phone Number	City, State, Zipcode
1

Routing Number
Account Number
Please choose one account type

CheckingSavings
PLEASE CHOOSE ONE OF THE FOLLOWING FOR THIS ACCOUNT:

	Percentage of Net Pay	Fixed Amount	Remainder of Check
Amount Deposited

(OPTIONAL) Add a second account

If you want 100% of your check to go into the first account provided - Skip this section.

Banking Information

	Name of bank #2	Phone Number	City, State, Zipcode
2

Routing Number
Account Number
Please choose one account type

CheckingSavings
PLEASE CHOOSE ONE OF THE FOLLOWING FOR THIS SECOND ACCOUNT:

	Percentage of Net Pay	Fixed Amount	Remainder of Check
Amount Deposited

Direct Deposit Verification

To ensure 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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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 and/or First Security Banks to make correcting adjustments.
Email Address
example@example.com
Date

MonthDayYear
Date
I wish to cancel any and all previous direct deposit information on file (if any) and use the newest account information provided above.
Signature

Clear

Wisely Cash Card Enrollment Form (OPTIONAL)

This form is for the Wisely Cash Card ONLY. If you have a bank you would like to use for direct deposit instead, use the direct deposit form and skip this one. (Wisely Cash Card will be issued from us along with an account number)
First Name
First Name
Last Name
Last Name
Middle Initial
Middle Initial
Email Address
Email Address
Telephone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date Of Birth
Social Security Number
WE NEED A VALID MAILING ADDRESS, ESPECIALLY IF YOUR PAY CARD WILL BE MAILED TO YOU. INCLUDE APARTMENT NUMBERS, LOT NUMBERS, UNIT NUMBERS, ETC.
MAILING ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
IF YOUR MAILING ADDRESS IS A PO BOX, PLEASE, LIST YOUR PHYSICAL ADDRESS:
PHYSICAL ADDRESS (IF DIFFERENT THAN MAILING ADDRESS)

Street Address

APT/LOT/UNIT

CityState / Province

Postal / Zip Code
TWO FORMS OF IDENTIFICATION MUST BE PROVIDED
This authority will remain in full force and effect until written notification from me of its termination/change. If an error of under deposit or over deposit is distributed into my account, I authorize Citizens and/or First Security Banks to make correcting adjustments.
Signature

Clear

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
Social Security Number*
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".
Signature - This form is not valid unless you sign it*

Clear
Date*

MonthDayYear
Todays Date

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.
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.
Filing Status*

SingleMarriedMarried, but withhold at higher single rate
Allowance 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
Additional allowances: You may claim additional allowances if you itemize your deductions or have other state tax credits that lower your tax.
Enter the number of additional allowances, if any.
Total 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” here
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” here 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” here.
Please check instructions to verify status of exemption
Should be Empty:

APPLICATION FOR EMPLOYMENT

NAME:

ADDRESS:

EDUCATION INFORMATION

EMPLOYMENT HISTORY :

Read the following, then continue

PERMISSION TO PERFORM BACKGROUND CHECK

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

EMERGENCY CONTACT INFORMATION

Direct Deposit

Direct Deposit Form (OPTIONAL)

PLEASE CHOOSE ONE OF THE FOLLOWING FOR THIS ACCOUNT:

(OPTIONAL) Add a second account

PLEASE CHOOSE ONE OF THE FOLLOWING FOR THIS SECOND ACCOUNT:

Wisely Cash Card Enrollment Form (OPTIONAL)

IF YOUR MAILING ADDRESS IS A PO BOX, PLEASE, LIST YOUR PHYSICAL ADDRESS:

TWO FORMS OF IDENTIFICATION MUST BE PROVIDED

Employee Withholding Certificate (W-4)

State of Arkansas- Employee Withholding Exemption Certificate (AR4EC)

Oklahoma Tax Commission- State Withholding Allowance Certificate