Job Application - Career Employment Service, Inc.

General Information

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. You are not required to answer any of the following questions that you feel infringe on your privacy.

Name *

Home Phone *

Cell Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Email Address *

Minimum Salary you will accept *

Desired Occupation

Are you available to work:Full TimePart TimeShift WorkTemporary

Occupation First Choice *

Years Experience *

Occupation Second Choice *

Years Experience *

Date Available *

Month

Day

Year

May we call you at work? *YesNo

Work Phone

If currently employed, why do you desire to change your position?

Education

Business Training

Did you attend a Business Training School or Votech? *YesNo

Name of School *

Course *

Graduated

Month

Day

Year

Special Training

Skills

Call Center SkillsCall Center: Help DeskCall Center: InboundCall Center: OutboundCheck all that apply

Insurance & Legal SkillsInsurance: MedicalInsurance: Property & CasualtyInsurance: Policy WritingLegalCheck all that apply

Medical & Insurance SkillsX-RayMedical AssistantMedical CodingMedical CertificationsCheck all that apply

Other Skills, Certifications, or Licenses

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude: organizations which indicate race, color, religion, gender, national origin, handicap, or other protected status.

Previous Employer

Employer *

Employment Start Date *

Month

Day

Year

Employment End Date *

Month

Day

Year

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Supervisor *

Phone *

Work Performed *

Have you ever been discharged from a position? *YesNo

Explain *

Where did you hear of our service *

Are you a veteran of the U.S. Armed Forces? *YesNo

What branch? *

Length of Service *

Date of Discharge *

Month

Day

Year

Have you ever been convicted of a felony? *YesNo

Explain *

References

Please give three references other than relatives.

Reference 1 Name *

Reference 1 Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Reference 2 Name *

Reference 2 Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Reference 3 Name *

Reference 3 Phone *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Signature

I certify that the information contained in this application is correct to the best of my knowledge, and understand that falsification of this application in any detail is grounds for disqualification from further consideration or for dismissal from employment in accordance with company policy. I acknowledge that consideration for employment is contingent on the results of reference and background checks. Therefore, I hereby authorize the company to (1) investigate the truthfulness of all statements made on this application, (2) contact my former employers and other listed references or any other person who can verify information, and (3) discuss the results of any investigation with other employees of the company involved in the hiring process. In addition, I give my full consent for all contracted persons including former employers to provide information concerning this application, and I release each such person from liability for providing information to the company.

Digital Signature *

Date *

Month

Day

Year

General Information

We are an equal opportunity employer, dedicated to a policy of nondiscrimination in employment on any basis including race, color, age, sex, religion, disability or national origin. You are not required to answer any of the following questions that you feel infringe on your privacy.

Desired Occupation

Education

Skills

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude: organizations which indicate race, color, religion, gender, national origin, handicap, or other protected status.

References

Please give three references other than relatives.

Signature

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Address

Phone

Fax

Working Hours

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