online-app-form

Contact Information

First Name

Middle Name

Last Name

Street Address

City

State

Zip Code

Home Phone

Business Phone

Mobile Phone

Email

Position Applied For

Position

Date You Can Start

Work Authorization

Are you 18 years of age or older?

Yes No

Have you ever worked for CSI L.L.C. before?

Yes No

If Yes, When?

Are you authorized to work in the United States of America?

Yes No

License/Convictions

Do you have a valid Driver’s License?

Yes No

If Yes, which state are you licensed in?

Have you ever been convicted of/or plead guilty to a misdemeanor other than a traffic violation? (Please note that a misdemeanor “other than a traffic violation” includes, but not limited to: OWI, DUI, Driving Under Suspension and all other indictable offenses).

Misdemeanor

Yes No

If Yes, please describe the misdemeanor

Have you ever been convicted of/or plead guilty to a felony?

Felony

Yes No

If Yes, please describe the felony

NOTE: A conviction or plea does not automatically eliminate you from employment since nature of the crime and type of job for which application is made will be considered

Education / Training

Please list High School, Trade, Business or College attended.

High School

Highest Grade Completed

Graduated

Yes No

Currently Attending

Yes No

Trade School

Highest Grade Completed

Major

Degree Earned

Graduated

Yes No

Currently Attending

Yes No

Business School

Highest Grade Completed

Major

Degree Earned

Graduated

Yes No

Currently Attending

Yes No

College

Highest Grade Completed

Major

Degree Earned

Graduated

Yes No

Currently Attending

Yes No

Employment / Experience

Give complete employment recorded for the last ten (10) years, starting with your present or last employer and work back.

Current Employer

Phone Number

Work Dates

Job Title

Rate of Pay

Reason for Leaving

Duties

May we contact this employer for a reference?

Yes No

Past Employer

Phone Number

Work Dates

Job Title

Rate of Pay

Reason for Leaving

Duties

May we contact this employer for a reference?

Yes No

Past Employer

Phone Number

Work Dates

Job Title

Rate of Pay

Reason for Leaving

Duties

May we contact this employer for a reference?

Yes No

Past Employer

Phone Number

Work Dates

Job Title

Rate of Pay

Reason for Leaving

Duties

May we contact this employer for a reference?

Yes No

Past Employer

Phone Number

Work Dates

Job Title

Rate of Pay

Reason for Leaving

Duties

May we contact this employer for a reference?

Yes No

References

List three personal references who know you well but who are not previous employers or relatives.

Name

Address

Phone

Name

Address

Phone

Name

Address

Phone

Referred By

Please enter the name of the person who referred you to apply at CSI, L.L.C. (if applicable).

NOTICE:
To the fullest extent permitted by the state and federal law, the employer will consider all information concerning an applicant or an employee in making hiring, firing and other employment-related decisions. The term "all information" includes information of any kind (verbal, written, photographic, video-graphic, etc.) that is in any medium (print, electronic, etc.) from any source. The employer will consider public information and other information to which it has lawful access. This may include information that is contained in social networking sites blogs, and other electronic sites, such as YouTube. If there is information that pertains to you that you believe requires explanation, interpretation, or clarification when it is considered by the employer, it is your obligation to communicate this information to the employer.

ACKNOWLEDGEMENT:
I have read and I understand the notice provided to me by the employer regarding information that the employer may consider in making hiring, firing, and employment-related decisions. I acknowledge that I have been given the opportunity to provide information to the employer that I wish the employer to consider in making its decisions.

CERTIFICATION:
I hereby certify that all statements made by me in this application and all related information which I have provided are true, accurate and complete to the best of my knowledge. I understand that if I provide any false, inaccurate, or incomplete information, I will not be eligible for employment, or, if I am hired, I may be terminated regardless of the date on which the employer discovers information concerning a violation of this certification. I hereby authorize CSI, L.L.C. to contact any of the employers listed above to verify employment and work record. I authorize CSI, L.L.C. to verify and investigate through law enforcement agencies that status of my driver's license and to conduct any background check it deems necessary.

NOTE: All applicants will receive consideration without regard to race, color, religion, sex, age, national origin, or handicap.

Affirmative Action - Equal Opportunity Employer

Signature

Date Signed

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