Employment Application

Personal Information

First Name *

Middle Name

Last Name *

Email *

Street Address *

City *

State *

Zip *

Telephone *

Are you 18 or older? *NoYes

Are you prevented from lawfully becoming employed in this country because of your visa or immigration status? *NoYesProof of citizenship/immigration status will be required.

Have you been convicted of a felony in the last 7 years? *NoYes

Employment Desired

Requested Position *

Date you can start *

Have you been employed with us before? *NoYes

Employment History

Company Name *

Company Address *

Previous Job Title *

Supervisor Name *

Supervisor's Phone *

Are you currently employed with this employer? *NoYes

Wage/Hour or Salary/Year *

Employed From *

Month *

Day *

Year *

If you do not remember the day, get as close as you can.

Last Day Employed *

Month *

Day *

Year *

Applicant's Statement

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all the statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this period should inquire as to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. Any dispute which arises between employer and employee must be resolved by arbitration in accordance with the rules of the American Arbitration Association. In the event of employment, I understand that false or misleading information given in the application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the employer.

Signature *

C&S Lease Service is an equal opportunity employer and does not discriminate on the basis of race, color, religion, gender, age, sexual orientation, national origin or ancestry, physical or mental disability, marital status, pregnancy, veteran status, medical condition, or any other protected status as defined by the law.