CES Job Application Form

CROSS ENVIRONMENTAL SERVICES, INC. (CES)

P.O. BOX 1299 • CRYSTAL SPRINGS, FL 33524 • (813) 783-1688
APPLICATION FOR EMPLOYMENT
(PRE-EMPLOYMENT QUESTIONAIRE)
(AN EQUAL OPPORTUNITY EMPLOYER AND DRUG-FREE WORKPLACE)
Social Security No.*
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
E-mail*
example@example.com
Birth Date*

MonthDayYear
Position Applying For*
Date You Can Start*

MonthDayYear
Date
Please select which location you applying for?*

Fort Walton BeachPompano BeachCrystal Springs
What special qualifications do you have?*
What machines (office or production) can you operate?*
What software packages can you operate?*
Are you at least 18 years old?*

YesNo
Are you either a US citizen or an alien authorized to work in the United States?*

YesNo
Have you been convicted of Misdemeanor or Felony within the last 5 years? If yes, please describe*
I am capable of lifting 50 lbs of weight from ground level to chest level*

YesNo
* You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.
MILITARY SERVICE RECORD
Branch of Service
Discharge Date

MonthDayYear
Date
Rank
Present membership in National Guard or Reserves
Date Obligation Ends

MonthDayYear
Date
EDUCATION
High School
Name of High School Attended
Number of Years Attended
Graduated?

YesNo
College
Name of College/University Attended
Number of Years Attended
Area of Study/Degree
Graduated?

YesNo
Graduate School
Name of Graduate School Attended
Number of Years Attended
Area of Study/Degree
Graduated?

YesNo
EMPLOYMENT EXPERIENCE
Current Employer
Name of Current Employer or NONE if not Employed
Position
Current Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
May We Contact?

YesNo
Previous Employer
Name of Previous Employer
Position
Starting Salary ($)
Previous Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Previous Employer
Name of Previous Employer
Position
Starting Salary ($)
Previous Salary ($)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
* All CDL applicants who have held a CDL for 10 years must provide previous employment information for all employers during the preceding 10 years. During periods of unemployment, list dates and write “unemployed” in employer information. If you have not had a CDL for 10 years, provide information back to the date you first obtained CDL license. Attach additional sheets if necessary.
References:
Reference 1
Name of Reference
Relationship
Phone Number
Please enter a valid phone number.
Reference 2
Name of Reference
Relationship
Phone Number
Please enter a valid phone number.
Reference 3
Name of Reference
Relationship
Phone Number
Please enter a valid phone number.
PLEASE FILL OUT, IN FULL, FOR CONSIDERATION FOR EMPLOYMENT:
How did you learn about us?*

AdvertisementFamily/FriendWalk-inEmploymentAgencyRelativeOther
To your knowledge, do you have any relatives working here currently?*

YesNo
Have you ever filed an application with us before? If Yes, when?*
Have you ever been employed with us before? If Yes, when?*
Are you available to work:*

Full timePart timeTemporary
Can you travel if a job requires it?*

YesNo
We are a drug-free workplace. It is a condition of employment for an employee to refrain from reporting to work or working with the presence of drugs or alcohol in his or her body and, if an injured employee refuses to submit to a test for drugs or alcohol, the employee forfeits eligibility for medical and indemnity benefits.
I understand that I may be required and I agree to take a pre-employment drug test.*

YesNo
I understand that I may be required and I agree to take random / for cause drug tests. *

YesNo
Do you have a valid Florida driver’s license?*

YesNo
Do you have a CDL license? If Yes, how long?*
Do you have any related licenses or training certificates? If Yes, please list:*
List any special skills/equipment or training that you feel may be helpful in considering your application:
Resume

Cancelof
CDL Application Attachment

Cancelof
Click here to download the CDL Application
Voluntary Affirmative Action Information

Cancelof
Click here to download the Voluntary Affirmative Action Information
Send Application:
Please note: if you are hired, any misrepresentations about anything on this employment application will be cause for your immediate dismissal, even if the misrepresentation is discovered after you have been working a period of time.

By clicking the submit button below, I certify that all of the information provided by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time.

In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option.

I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company.
Date

MonthDayYear
Date
Signature

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CROSS ENVIRONMENTAL SERVICES, INC. (CES)

MILITARY SERVICE RECORD

EDUCATION

EMPLOYMENT EXPERIENCE

References:

PLEASE FILL OUT, IN FULL, FOR CONSIDERATION FOR EMPLOYMENT:

Send Application: