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| First name: | |
| Last name: | |
| Email address: | |
| Daytime phone: | |
| Evening phone: | |
| Home address: | |
| City: | |
| Country: | |
| State/Province: | |
| Zip/postal code: | |
| Other names used for employment and dates of use: | |
| Previous addresses in last 7 years (if different): | |
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| Job position for which you are applying (if known): | |
| Status/shift preferred: | |
| Desired salary: | per |
| When can you start? | |
| How did you find CSC? | |
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| High school name/address: | |
| Highest grade: | 9 10 11 12 |
| High school diploma? | Yes No |
| College name and address: | |
| Years completed: | 1 2 3 4 |
| College degree? | Yes No |
| | If yes, specify: |
| Graduate school name and address: | |
| Years completed: | 1 2 3 4 |
| Graduate degree? | Yes No |
| | If yes, specify: |
| Vocational school name and address: | |
| Years completed: | 1 2 3 4 |
| Vocational certificate? | Yes No |
| | If yes, specify: |
| Other licenses or certificates: | |
| Applicable skills: | |
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| Start with your present or last job. Include any job-related military service assignments or volunteer activities. You may exclude organizations that indicate race, color, religion, national origin, disabilities, or other protected statuses. |
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| Company name/address: | |
| Supervisor name, title, and phone number: | |
| Your position/title: | |
| Dates employed: | Starting: Ending: |
| Hours per week: | |
| Describe your job responsibilities: | |
| Salary: | Starting: Ending: |
| Reason for leaving: | |
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| Company name/address: | |
| Supervisor name, title, and phone: | |
| Your position/title: | |
| Dates employed: | Starting: Ending: |
| Average hours per week: | |
| Describe your job responsibilities: | |
| Salary: | Starting: Ending: |
| Reason for leaving: | |
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| Company name/address: | |
| Supervisor name, title, and phone: | |
| Your position/title: | |
| Dates employed: | Starting: Ending: |
| Average hours per week: | |
| Describe your job responsibilities: | |
| Salary: | Starting: Ending: |
| Reason for leaving: | |
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| Do you have relatives employed by CSC? | Yes No If yes, specify: |
| Have you ever worked for CSC in the past? | Yes No |
| Can you work overtime? | Yes No |
| Are you willing to travel? | Yes No |
| Additional disclosures: | |
| Are you legally able to be employed in the U.S.? (Proof of eligibility will be required upon employment.) |
| | Yes No |
| If under 18 years of age, can you submit a work permit after employment? |
| | Yes No N/A |
| Are you capable of performing in a reasonable manner, with or without reasonable accomodation, the activities involved in the job or occupation for which you have applied? (Do not answer this question unless you have been informed about the requirements of the job for which you are applying.) |
| | Yes No |
| We may contact any or all of your previous employers. Your current employer will be contacted prior to any employment offer only with your consent. May we contact your current employer prior to an employment offer? (If not, an offer may be contingent upon a satisfactory reference check from your most current employer.) |
| | Yes No |
| Have you ever been convicted of a felony? (Not all convictions will bar employment.) |
| | Yes No |
| Have you ever been convicted of a misdemeanor involving any violent act or act of dishonesty for which the record has not been sealed or expunged? (Not all convictions will bar employment.) |
| | Yes No |
Background Checks
This application form is not complete without a Disclosure Statement and Authorization for Obtaining a Consumer Report, which provides your authorization to obtain consumer reports such as criminal background checks. A background check is required as part of the CSC interview process. By this document, Corporation Service Company® (CSC) discloses to me that it may obtain a consumer report from Justifacts Credential Verification, Inc. (Justifacts) for employment purposes as part of the employment background investigation. I acknowledge that in the event that CSC® hires me, this authorization will remain on file and shall serve as an ongoing authorization for CSC to obtain consumer reports at any time during my period of employment.
I hereby authorize Justifacts to investigate my background to determine any and all information of concern to my report, whether same is of record or not. I release employers and persons named in my application from all liability for any damages on account of his/her furnishing said information.
Additionally, Justifacts is hereby authorized to make any investigation of my personal history, educational background, military record, motor vehicle records, criminal records and credit history through an investigative or credit agency or bureau of your choice. I authorize the release of this information by the appropriate agencies to the investigating service.
If you are applying for a position that requires you to drive during the course of your workday at least once weekly, CSC will also need to conduct a department of motor vehicles check. If you are not sure if this position requires you to drive on behalf of CSC, please inquire with a CSC representative. |
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CSC Web Site License Agreement
I hereby certify that the information I have provided on this application and its attachments is true and correct to the best of my knowledge and that no attempt has been made to conceal any pertinent information. I understand that any material error or omission of information may constitute grounds for denial of employment or subject me to termination at any time during my employment. Unless otherwise noted on this application, I authorize my previous employers, references, and other persons or institutions noted on this application to provide CSC with any information they may have regarding me. I agree to hold harmless all persons supplying this information to CSC and all of its agents and associates for any and all liabilities arising out of their investigation of my application of employment. Negative results obtained on a consumer report authorized by me on a separate disclosure and authorization form may result in the rescinding of an employment offer, or separation of employment if employment has commenced. I understand that it is CSC's policy to make reasonable accommodation to the known physical or mental limitations of an otherwise qualified applicant, and not to refuse to hire this person because of the need for such accommodation, unless such accommodation places an undue hardship on the operation of its business. I understand that my application is being considered only for the specific position for which I have applied, and that my application will remain active for no more than sixty (60) days. If I am not hired for this position and subsequently become interested in any future job opportunities that may become available, I will need to reapply to CSC. I further agree that if hired, I will be required to comply with all rules and regulations of CSC. I understand that CSC's benefits, rules, policies and regulations may be changed, modified, deleted or added to by CSC at any time at CSC's sole option and without prior notice. I acknowledge and agree that my employment, if hired, is at will. My employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at the option of either CSC or me. Furthermore, no oral or other representations made, regardless of who makes them, shall be effective to modify these terms and conditions so as to create any agreement of employment, either express or implied. I agree that I am not guaranteed any term of employment for any specified period of time or contrary to the terms and conditions stated herein.
By submitting this template, you agree that you have read and accept the terms of the CSC Web Site License Agreement. |
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| I accept these terms: | Yes No |
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