CCS Job Application-English

CCS Headquarters 12621 N 148th Street Waverly, NE 68462 (855) 752-5047 - Phone
Employment Application
*** Please read employment application instructions before completing this form ***
POSITION FOR WHICH YOU ARE APPLYING
Check all that you may be interested in: Full-Time
Name

First NameMiddle InitialLast Name
Address

Mailing Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parish
Address

EMail Address

Street Address Line 2

CityState

Zip
Drivers License
State
Expiration Date

MonthDayYear
Expiration Date
Have you been convicted of a felony since your 18th birthday? If you answered yes, please complete the following: (Conviction is not an automatic bar to employment. Each case is considered on its individual merits.
Nature of Offense
Name Location of Court
Date of Conviction

MonthDayYear
(Inaccurate information here will result in disqualification

Have you ever been discharged or forced to resign from any position? If yes, please give employer, date and Date and Reason reason.
Employer
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.
Type a question

YesNo
REFERENCES
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
EDUCATION AND TRAINING
ELEMENTARY AND HIGH SCHOOL EDUCATION

Highest Grade Completed (choose one) Did you graduate from High School or obtain a GED?

Name and Location of Last School Attended

(High School, Junior High or Elementary)
Grade Level Finished

122456789101112Other
Did you graduate from high school or obtain a GED?
Type a question

YesNo
Name and Location of Last School Attended
Name
Location
Secondary Education
Years Complete (choose one)

123345678Other
Did you obtain a degree?

YesNo
Name and Location of Last School Attended
Name
Location
EMPLOYMENT HISTORY
May we contact your present/past employer?

YesNo
Starting Date month day year

MonthDayYear
Ending Date month day year

MonthDayYear
Employer Company Name, Address, City and State are required
Hours per Week
Name Title of Immediate Supervisor
Reason for Leaving
Rate of Pay When Left
Title of Position Held
Describe job responsibilities in order of importance
Starting Date month day year

MonthDayYear
Ending Date month day year

MonthDayYear
Employer Company Name, Address, City and State are required
Hours per Week
Name & Title of Immediate Supervisor
Name Title of Immediate Supervisor
Reason for Leaving
Rate of Pay When Left
Rate of Pay When Left
Title of Position Held
Describe job responsibilities in order of importance
Starting Date month day year

MonthDayYear
Ending Date month day year

MonthDayYear
Employer Company Name, Address, City and State are required
Hours per Week
Name Title of Immediate Supervisor
Reason for Leaving
Rate of Pay When Left
Rate of Pay When Left
Title of Position Held
Describe job responsibilities in order of importance
CONDITIONS OF EMPLOYMENT STATEMENT

Under penalties of perjury, I declare that my answers to the questions on this application and any necessary examinations and supplements are true and give 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.

Iunderstand 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. I 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.
Unsigned applications will not be considered
Date

MonthDayYear
Signature (Unsigned applications will not be considered)
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.

Completed Applications may be returned to:

Via email to Jessica@ccsgrouponline.com Via postal mail to: 12621 N 148th Street, Waverly, NE 68462
Should be Empty:

Employment Application

REFERENCES

EDUCATION AND TRAINING

Did you graduate from high school or obtain a GED?

Name and Location of Last School Attended

Secondary Education

Name and Location of Last School Attended