APPLICATION FOR EMPLOYMENT

APPLICATION FOR EMPLOYMENT
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
First Name*
Middle Name
Last Name*
Address*
City*
STATE*
ZIP*
PHONE NO.*
SOCIAL SECURITY NO*
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
HAVE YOU WORKED UNDER ANOTHER NAME
VEHICLE MAKEMODEL
LICENSE PLATE NO
EMPLOYMENT DESIRED
REFFERED BY
DATE TO START

MonthDayYear
Date
PAY DESIRED
Are you employed now?

YesNo
IF so, MAY WE CONTACT THE EMPLOYER
Ever applied to CFSI before?

YesNo
IF so WHEN DID YOU APPLY DATE

MonthDayYear
Date
Education Type
Name/Location of School
Years Attended
Graduated
Subjects
Education Type
Name/Location of School
Years Attended
Graduated
Subjects
Education Type
Name/Location of School
Years Attended
Graduated
Subjects
U.S. Military Service
Rank
HAVE YOU BEEN CONVICTED OF A FELONY WITHIN THE LAST FIVE (5) YEARS?

YesNo
IF so WHEN WHAT CHARGE
EMPLOYMENT HISTORY
UPLOAD RESUME

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FORMER EMPLOYERS: LIST BELOW FIVE EMPLOYERS STARTING WITH THE LATEST ONE FIRST
From
To
Name and Address of Employer
Pay Rate
Position
Reason For Leaving
From
To
Name and Address of Employer
Pay Rate
Position
Reason For Leaving
From
To
Name and Address of Employer
Pay Rate
Position
Reason For Leaving
From
To
Name and Address of Employer
Pay Rate
Position
Reason For Leaving
From
To
Name and Address of Employer
Pay Rate
Position
Reason For Leaving
GIVE BELOW NAMES OF TWO REFERENCES NOT RELATED TO YOU, WHOM YOU HAVE KNOWN MINIMUM OF ONE YEAR. YEARS KNOWN PHONE NO. ADDRESS NAME

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 reportand 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.
Name
Address
Phone Number
Years Known
Name
Address
Phone Number
Years Known
SIGNATURE OF APPLICANT*

Clear

Drug and Alcohol Testing Consent Form

VALID STATE ISSUED I.D. MUST BE PROVIDED AT TIME OF TESTING

You may be tested for drugs and alcohol in the instances listed below. The testing will be conducted by a qualified laboratory. All positive test results will be confirmed by means of testing other than which resulted in the initial positive result. Positive test results may result in termination of employment or removal from employment consideration. This consent form authorizes the release of the test results to the agency. If you refuse the testing, you will be considered in violation of this policy and will be subject to possible termination and/or will not be considered for employment.

1. Pre-employment- before becoming employed

2. Reasonable cause testing- where there is a resonable cause to believe that you are under the influence of a mood altering substance or otherwise violating this policy. You may be asked by supervisory personnel to report for a drug and alcohol test at company expense.

3. Medical aid and/or lost time incident- if you require medical aid for a work related incident and/or are involved in a lost time accident, you may be required to report for a drug and alcohol test at compant expense.

On the Job Injury

In the event of an on the job injury, you are required to report the incident immediately to your supervisor. You will then report to this agency. Our preferred providers for the job injuries are: Med express (AR)- Baptist Health Hostpital (Fort Smith, AR)- Oklahoma Medical Center (Poteau, OK)

After receiving medical attention, you must report back to this agency to sign required medical forms and turn in medical bills/paperwork resulting from the injury.

I have read the policy above. I understand the content of this policy and I have received a copy.
Signature of Employee*

Clear
Should be Empty:

APPLICATION FOR EMPLOYMENT

EMPLOYMENT HISTORY

FORMER EMPLOYERS: LIST BELOW FIVE EMPLOYERS STARTING WITH THE LATEST ONE FIRST