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Personal Information

Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Email Address *

Cell Phone # *

Cell Service Provider

Alt Phone #

Emergency Contact Name/Phone #

Have you ever applied for employment with C&S? *YesNo

Please enter the month and year you applied.

Are you over the age of 18? *If no, hire is subject to verification of minimum legal age.YesNo

Are you legally eligible for employment in the United States? *YesNo

Do you possess a valid driver's license? *YesNo

What is your means of transportation?

How many miles are you willing to travel for work?

What is the type of work desired?

What is the number of hours you're able to work weekly?

Will you work overtime?YesNo

What date can you begin work?

Month

Day

Year

Lowest Accepted Salary

USD

Desired career placementCheck all that apply.Temporary OnlyTemp-to-HireConsider me for both

Do you write or speak any foreign language?

How are you proficient in that/those language(s)?OralWritten

Please list the languages in which you're proficient.

Any physical or mental disabilities which do not prevent employment but should be considered in your job placement?YesNo

Please List or Describe

Indicate your lifting ability

Have you ever been convicted? *YesNo

Please describe

If required, are you willing to take a drug/alcohol test? *YesNo

How did you hear about C&S Employment Solutions?Please select the primary source.

List source

Please list referral's name

Education

Name of High School with City and State

Select

Name of University/College/Tech/Vocational

City/State of School

Major

Minor

Completed?YesNo

Degree/Certification

Year Completed

Employment History

Please add up to three employers.

Employer Information

Company Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Company Phone

Skills/Experience

Specialty/Trade ExperiencePlease add all that apply.

Specialty/Trade

Years

Office Experience

Type of Experience

Years

Bookkeeping Experience

Type of Experience

Years

Computer Experience

Type of Experience

Years

Labor Experience

Type of Experience

Years

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