Contact Crystal Structures ~ CSGlazing

Personal Information

Full Name*

First Middle Last

Email*

Phone*

Current Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Previous Address

If at current address less than 2 years

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your present employment status

Employed
Self-Employed
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Student

What position are you applying for?

Availability

Available Start Date*

How many hours are you available to work?*

Check all that apply

Full Time
Part Time
Temporary

Which schedule are you available to work?*

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Weekdays
Weekends
Evenings
Nights
Overtime
Shift

Job Related Skills

If the job requires, do you have the appropriate valid driver's license?*

Yes
No

Have you had any moving violations?*

Yes
No

If yes, please explain:*

Have you been given a job description or had the requirements of the job explained to you?*

Yes
No

Do you understand the job requirements?*

Yes
No

Can you perform the requirements of this job with reasonable accommodation?*

Yes
No

Security

Please list any other skills, licenses or certificates that may be job related or that you feel would be of value to this job or company.

List states and counties of residence for the last 7 years.

Have you used any names or social security numbers other than that given above?*

Yes
No

If yes, please give alternate names / social security number here:*

Have you been convicted of, or served time for a felony in the past 7 years?*

Yes
No

If yes, please describe with dates of conviction, type of charge, date of release / parole. (In accordance with company policy this information will be reviewed for job relatedness and time since last conviction)*

Education

Please select highest grade completed:*

If your school records are under a different name, please provide the name:

Name of High School*

Graduated High School?*

Yes
No

Name of College

Graduated College?

Yes
No

Degree

Previous Employers

Please note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. For employers outside the US, a current fax number is mandatory.

Company Name*

Current Employer?*

Yes
No

May we contact?*

Yes
No

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name*

Employer Phone*

Start Date of Employment*

End Date of Employment*

Reason for leaving*

Company Name*

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name*

Employer Phone*

Start Date of Employment

End Date of Employment*

Reason for leaving*

Company Name*

Company Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor Name*

Employer Phone*

Start Date of Employment*

End Date of Employment*

Reason for leaving*

References

Please provide reference information for 2 individuals who are familiar with your work ability. Do not include relatives.

Reference Name

Reference Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone

Years acquainted with reference?

Reference Name

Reference Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone

Years acquainted with reference?

Certification & Release*

I certify that I have read and understand the applicant note at the beginning of this application form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of the facts called for in this application may result in rejection of my application or discharge at any time during my employment. I authorize the company and / or it's agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.

Digital Signature*

By signing your name below you have formally signed this application and agreed to all terms.

Name

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