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Free Forms Job Application - DOC

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									                                                Application for Employment
Drug-Free Workplace                                                                                           Smoke-Free Environment
 Last Name                     First                  MI      Nickname                 Position Applied For                Date of Application


 Street Address                                                   City                                     State         Zip Code


 Home Telephone                         Alternate Telephone                   E-Mail Address


 How were you referred to
 our company?                  School       Advertisement        Employment     By an Employee             Open      Walk-in    Other (explain)
 (Check only one)                                                Agency         If yes, give name:         House


An Equal Opportunity Employer
It is the policy of CSI Leasing, Inc. not to discriminate and to provide equal employment opportunities to all qualified persons regardless of
race, color, creed, national origin, sex, age, marital status, sexual orientation, or citizenship status. We shall continue to provide equal
employment opportunity to Veterans of the Vietnam Era and to disabled Veterans and individuals with disabilities except where the
disability is a bonafide occupational disqualification.
Please read carefully, complete by printing in ink or typing and provide all information requested.
Applications that specify a particular open position will be maintained in our active files for six months from the date of application.
List all previous employers for the past 10 years, starting with the present or most recent employer. Include full-time, part-time and
summer jobs, self-employment, contracting, temporary agencies and periods of unemployment. You may attach a resume, but
completing all questions on this application is required for consideration.
Last or present company                       Type of business            Title or classification of job

Street Address                                Phone Number                Brief Description of Duties

City                         State            Zip Code

Supervisor’s Name              Supervisor’s Phone Number

Base Salary                    Dates Worked
                               From:                 To:
Reason for leaving

Last or present company                       Type of business            Title or classification of job

Street Address                                Phone Number                Brief Description of Duties

City                         State            Zip Code

Supervisor’s Name              Supervisor’s Phone Number

Base Salary                    Dates Worked
                               From:                 To:
Reason for leaving

Last or present company                       Type of business            Title or classification of job

Street Address                                Phone Number                Brief Description of Duties

City                         State            Zip Code

Supervisor’s Name              Supervisor’s Phone Number

Base Salary                    Dates Worked
                               From:                 To:
Reason for leaving
                                                     Application for Employment
Drug-Free Workplace                                                                                           Smoke-Free Environment
Last or present company                          Type of business            Title or classification of job

Street Address                                   Phone Number                Brief Description of Duties

City                            State            Zip Code

Supervisor’s Name                 Supervisor’s Phone Number

Base Salary                       Dates Worked
                                  From:                To:
Reason for leaving

Last or present company                          Type of business            Title or classification of job

Street Address                                   Phone Number                Brief Description of Duties

City                            State            Zip Code

Supervisor’s Name                 Supervisor’s Phone Number

Base Salary                       Dates Worked
                                  From:                To:
Reason for leaving

Last or present company                          Type of business            Title or classification of job

Street Address                                   Phone Number                Brief Description of Duties

City                            State            Zip Code

Supervisor’s Name                 Supervisor’s Phone Number

Base Salary                       Dates Worked
                                  From:                To:
Reason for leaving

Last or present company                          Type of business            Title or classification of job

Street Address                                   Phone Number                Brief Description of Duties

City                            State            Zip Code

Supervisor’s Name                 Supervisor’s Phone Number

Base Salary                       Dates Worked
                                  From:                To:
Reason for leaving

Last or present company                          Type of business            Title or classification of job

Street Address                                   Phone Number                Brief Description of Duties

City                            State            Zip Code

Supervisor’s Name                 Supervisor’s Phone Number

Base Salary                       Dates Worked
                                  From:                To:
Reason for leaving




       If additional space is needed, please request additional paper. All work history from the past 10 years must be entered on the application.

                                                                             2
                                                        Application for Employment
Drug-Free Workplace                                                                                                  Smoke-Free Environment
Educational History
School Name                                       Location                  Major Course or         # of Years    Graduated             Degree/Diploma
                                                 (city, state)                 Subject              Completed     Yes   No
High School

Technical/Trade (after high school)



College (list all attended)




Other education/ training




Outside Activities (which you feel may be relevant to the position)
(Exclude those indicating race, color, religion, sex, national origin, age or disability)
List of memberships in professional, trade, scientific or civic organizations relevant to this position:




Skills History (to be completed by applicant if applicable to the position)
Typing                        Yes            Words per minute:            Other types of machines, applicable to position:             Years experience
                              No
Dictation                     Yes            Words per minute:
                              No
Computer Skills
                         Hardware:

                           Software:
Please list other skills and/or equipment/language experience you have acquired which you feel my help you in this position:




Criminal History
Have you ever been convicted of and/or fined for the commission of a criminal offense, misdemeanor or felony, including driving under the
influence of alcohol or drugs, possession of illegal substances, theft, moving violations, but not including traffic citations such as running a red
light, speeding, reckless driving, etc.?            Yes            No
If yes, please explain when, where and type of conviction(s):

NOTE: Criminal convictions (including guilty pleas) do not automatically disqualify an individual from employment. Circumstances surrounding a
conviction, including the nature of the offense, the time of the offense and evidence of rehabilitation since the offense, will be reviewed and taken into
account in light of the position for which you are being considered. For purposes of this inquiry, SIS, probation, guilty plea, nolo contendere, etc. are all
convictions.




                                                                                  3
                                                       Application for Employment
Drug-Free Workplace                                                                                              Smoke-Free Environment
Military Record (Use N/A if not applicable)
Branch of Service:                                                                                           From:                  To:

Present military affiliation:               None                           Reserve (active)                           Reserve (non-active)

Date of final discharge:                                                   Rank at discharge:

Kinds of training and duty while in service that may be relevant to this position:




Professional/Work References
List two past supervisors and one person you are not related to who have knowledge of your qualifications for the position you are applying for.
                                                                         Address                 Phone number
Name                               Title/ Relationship        (street, city, state, zip code) (including area code)                 Occupation




May we contact your present employer?                  Yes                  No
If no, please explain:
Date available:                                                              Have you ever applied for employment with us?
Wage or Salary expectations:                                                      Yes        No
Will you work overtime, if asked?     Yes                  No                If yes, when:



 I hereby certify the information provided by me in this Application for Employment is true, correct and complete. I understand that any
  misstatement or omission of fact on this application shall be considered cause for not hiring, or for separation from the company’s
  service, if employed.

    I agree to and have signed an authorization to release information needed to perform background investigations as indicated on the
     authorization and release form with the knowledge that the form and the subsequent investigation(s) will become part of my application
     for employment or employee record.

    I understand that it is the company’s Policy to provide a drug free and smoke free working environment for its employees and I agree to
     comply with these policies.

    As a condition of my application for employment, I understand and agree to undergo drug screening if requested. I understand that if
     my test results are positive, I shall not be considered further by the company for this position at this time.

    I understand that an offer of employment is contingent upon complying with the Immigration Reform and Control Act of 1986.

    I understand that neither this application nor any other company communication or practice creates an employment contract or changes
     the fact that employment is at-will for an indefinite period and may be terminated at any time either by the company or me and that no
     employee or representative of the company, other than the CEO has the authority to enter into any employment contract or to change the
     at-will employment relationship or to make any agreement contrary to the foregoing.



                                Signature                                                                                    Date




                                                                                 4
                                                  CSI Leasing, Inc.
                                          Applicant Self-Identification Form
CSI Leasing, Inc. is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights
laws and regulations. In order to comply with these laws, CSI Leasing, Inc. invites applicants to voluntarily self-identify their
gender, race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse
treatment. The information will be kept confidential. It will only be used in accordance with the provisions of applicable laws,
executive orders and regulations, including those that require the information to be summarized and reported to the federal
government for civil rights enforcement. When reported, data will not identify any specific individual.

CSI Leasing, Inc. is an Equal Opportunity Employer.

Name:

Position Applied For:

Gender:                                  Male                 Female

Race/Ethnicity:

1.    Are you Hispanic or Latino?
      Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or
      origin, regardless of race.

          Yes                No

2.    If you answered “No” to Question 1, please select one of the following designations:

                White (Non Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle
                East or North Africa.

                Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial
                groups of Africa.

                Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the
                peoples of Hawaii, Guam, Samoa or other Pacific Islands.

                Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East,
                Southeast Asia or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea,
                Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.

                American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original
                peoples of North and South America (including Central America) and who maintain tribal affiliation or
                community attachment.

                Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above
                races, excluding those who identify themselves as Hispanic or Latino.

                 Please specify:

Thank you for your participation.

     I do not wish to self-identify.

Signature:      _________________________________

Date Completed:




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