Direct Deposit (Optional)
First Name Last Name Last 4 SSN Street Address City State Zip Name of Bank Phone Number City, State, Zip Routing Number Account Number Checking Savings This authority will remain in full force and effect until written notification from me of its termination or change. If an error or under deposit or over deposit is distributed into my account, I authorize Citizens Bank and Trust to make correcting adjustments.
First Name Last Name Date Signature
I understand CFSI Employment Services may text me concerning employment opportunities, and any reason that may concern my application, or to provide information at CFSI's discretion.
I understand I may respond to CFSI through text.
I understant standard text messaging rates may apply.
I Full Name give CFSI Employment Services permission to send me text notifications to the following text capable number. Phone Number
Safety Policy Statement
It is the policy of CFSI Employment Services to work continually toward improving our Safety Policy, as well as our safety procedures. It is the company's intent to provide a safe working environment and the actions of employees. Therefore, safety will take precedence over expediency or shortcuts. Every attempt will be made to reduce the possiblility of accident occurrences. Protection of employees, the public, company property and operation is paramount. Management considers no phase of the operation more important than the health and safety of the employee. The management of this company will not knowingly send/lease employees to facilities with known, uncontrolled hazardous working conditions. Employee safety is to be the first consideration in the operation of business. Safe practices on the part of the workers must be part of all operations. Employees must understand ther personal responsibility for the preventionp on injuries on and off the job. Accident prevention and efficent production go hand-in-hand. All injuries can and should be prevented! Management will continue to be guided and motivated by this policy, and with the cooperation of all employees, will actively pursue a safer working environment throughout the company.
CFSI EMPLOYMENT SERVICES STAFF
PLEASE READ EACH SAFETY RULE
Patterned after the Federal OSHA requiremnts, CFSI has developed thesee safety rules for all employees. Read and become familiar with these rules and other rules that apply to our employees. All employees must fully understand and comply with these rules. Failure to do so may result in termination of employment.
First Name* Last Name* Date* Signature*
INJURY REPORTING PROCEDURE
CONTACT CFSI AND YOUR SUPERVISOR IMMEDIATELY!
In the event of a work related accident/injury, no matter how slight the accident/injury may be, please contact CFSI AND your supervisor immediately. If you do not follow this procedure, there is a chance you may not be covered by our worker's compensation insurance.
NON-EMERGENCY MEDICAL ASSISTANCE: (During Business Hours)
NON-EMERGENCY MEDICAL ASSISTANCE: (After Business Hours)
EMERGENCY MEDICAL ASSISTANCE: (During Business Hours)
EMERGENCY MEDICAL ASSISTANCE: (After Business Hours)
CFSI CAN BE REACHED 24 HOURS A DAY, 7 DAYS A WEEK AT THE FOLLOWING PHONE NUMBERS.
479-782-7563 479-650-3501 800-613-2374
If you have any questions and/or suggestions, please give us a call.
Thank you for your cooperation,
The clinic we use is: MedExpress.
The hospitals we use are: Baptist Health, Fort Smith, AR/Oklahoma Medical Center, Poteau, OK.
CHECK PICK-UP PROCEDURE AND CASH ADVANCE INFORMATION
MUST PROVIDE VALID STATE ISSUED PHOTO ID TO PICK UP CHECKS!
If you come to pick up your check or cash advance from the CFSI office, you must present your valid state issued ID in order to receive your check. Even if we know you, you are still required to present a valid id each time to receive your check. NO EXCEPTIONS! This is to make sure the right check is given to the right person.
You can have another person pick up your check with a SIGNED AND DATED note from YOU stating they are allowed to pick up your check or cash advance. They must provide the note AND their valid state issued ID. The signature will be compared to your signature of your application.
CASH ADVANCES ARE AVAILABLE MONDAY THROUGH FRIDAY!
For an employee to receife a cash advance you must meet the following criteria:
Your request for a cash advance WILL NOT be official UNLESS you talk to a CFSI representative over the phone or in the office. Requests WILL NOT be taken after hours or from voicemail. Cash advances will NOT be ready until after 2:00 pm. Please call after this time to see if your advance is ready.
Employees are only allowed ONE (1) cash advance per week.
Some companies do not disperse cash advances. We will let you know if you work for one of these companies. If you have any questions, feel free to ask.
First Name* Last Name* Date* Signature*
I, First Name* Last Name* , hereby give consent to any and all previous employers of mine to provide information regarding my employment prior to CFSI Employment Services. This consent is given in accordance to ACT 1474 of the 1991 General Assembly of the State of Arkansas. Date*
The following may be disclosed:
RULES FOR CFSI EMPLOYMENT SERVICES
Faiure to comply with these rules may cause you to be disqualified for unemployment benefits or any other benefits you may otherwise have been eligible for.
IF YOU ARE TERMINATED...IF YOUR ASSIGNMENT IS COMPLETE...
IF YOU QUIT...
PLEASE MAKE SURE YOU CONTACT OUR OFFICE THE SAME DAY YOU ARE TERMINATED, YOUR ASSINGMENT IS COMPLETED, OR YOU QUIT, (THIS INCLUDES LONG TERM TEMP JOBS, IF YOU HAVE GONE PERMANENT, OR IF WE DO THE PAYROLL ONLY). IT IS YOUR RESPONSIBILITY TO LET US KNOW WHY YOU ARE NO LONGER AT YOUR ASSIGNMENT. IT IS YOUR RESPONSIBILITY TO ASK FOR ANOTHER ASSINGMENT AND TO BE PUT ON THE AVAILABLE LIST. IF YOU FAIL TO CONTACT OUR OFFICE AND ASK FOR ANOTHER ASSIGNMENT, YOU MAY BE DISQUALIFIED FROM UNEMPLOYMENT BENEFITS OR ANY OTHER BENEFITS YOU MAY HAVE OTHERWISE BEEN ELIGIBLE. WE HAVE A 24 HOUR PHONE LINE IN WHICH YOU MAY LEAVE A MESSAGE. WHEN YOU CALL, MAKE SURE YOU GET THE NAME OF THE PERSON WITH WHOM YOU SPOKE. IF YOU ARE ASSIGNED TO A POSITION AND WALK OFF THE JOB, YOU WILL BE PAID THE CURRENT MINIMUM WAGE.
I authorize any physician who has examined or treated me to release all releveant information requested by CFSI regarding my physical condition and previous treatment. I consent to a full medical examination by a physician of CFSI's choosing to include but not limited to the testing of my urine and blood for any indications of alcohol or drug use. I consent to the administration of X-rays of my chest and back. I give consent for all information obtained as a result of my physical examination and all other relevant medical informaiton to be released to CFSI.
If I am hired by CFSI Employment Services, their authorizations for examinations, testing, and medical release of the relevant information will continue to be in effect for the durations of my employment. I certify the informations to be true and correct. Any misstatement of facts is cause for rejection or dismissal.
PERMISSION TO PERFORM BACKGROUND CHECK
I, First Name* Last Name* Date of Birth* Last 4 SSN* Current Address: Street address* City* State and Zip* County* Previous Address: Street address City State and Zip County Date
Give CFSI Employment Services and/or Century Leasing authorization to perform a check on my background, including but not limited to: Criminal Record, Past Employment History, Personal References
As appropriate for employment in which I have applied and/or have been hired thorugh CFSI Employment Services. This includes companies other than CFSI Employment Services, in which CFSI Employment Services has hired me for or any company interestedin hiring me.
I understand that I do not have to agree to this background check, but that refusal can and will exclude me from consideration as an employee for CFSI Employment Services and the companies that CFSI hire for.
This information is of a confidential nature, and as such will not be shared with other personnel except for those involved in the specific hiring process, which include CFSI Employment Services personnel, and management of the company that CFSI has hired me for.
I understand that this information will be kept for a period of two (2) years from the date of the background check.
All information collected will be kept confidential.
AUTHORIZATION AND REQUEST FOR INFORMATION
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 corportation, 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 angency 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.
First Name* Last Name* Date* Signature*
DRUG AND ALCOHOL TESTING CONSENT FORM
VALID STAT ISSUED ID 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. Postive test results may result in termination of employment or removal from employment consideration. This consent form authorizes the release of the test results to this 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.
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: MedExpress (AR) - Baptist Health (Fort Smith, AR) - Oklahoma Medical Center (Poteau, OK)
After receiving medical attention, you must report back to this agency to sign requried medical forms and turn in medical bills/paperwork resulting from the injury.