SECTION 1 : Applicant Information
|
| First Name (*) | |
| Last Name(*) | |
Address(*) | |
| Telephone Number | |
SECTION 2 : Application Information
|
| Position sought(*) | |
| How did you hear about us? |
Advertisement
Employment Agency
Friend
Relative
Walk-in
Other
|
| Date of application(*) | |
|
|
| Have you applied for a job with CIC in the past?* |
yes
no
|
If yes, when?
|
| Have you worked for CIC previously?(*) |
yes
no
|
If yes, when?
|
| Are you currently working? |
yes
no
|
Do you authorize us to contact your current employer? |
yes
no
|
| Are you prohibited from working in this country?(*) |
yes
no
|
| On what date will you be available to begin working?(*) |
|
| Are you currently on temporary leave from another job? |
yes
no
|
| Are you able to travel if the job requires it? |
yes
no
|
| Have you been convicted of a felony in the past 7 years?(*) |
yes
no
|
If yes, when?
|
SECTION 4 : Work Experience
|
Please list your last four employers and include
the following information for each: |
| Name of Employer #1 | |
| Employer address | |
| Dates employed | From: | To: |
| Position held | |
| Telephone number | |
| Name of Employer #2 | |
| Employer address | |
| Dates employed | From: | To: |
| Position held | |
| Telephone number | |
| Name of Employer #3 | |
| Employer address | |
| Dates employed | From: | To: |
| Position held | |
| Telephone number | |
| Name of Employer #4 | |
| Employer address | |
| Dates employed | From: | To: |
| Position held | |
| Telephone number | |
SECTION 5 : Education, Language and Special Skills
|
Please indicate the highest level of education
you have completed.(*) |
Elementary
High school
College
Graduate School
Some high school
some college
some graduate courses.
|
| Indicate any degrees or certifications you have received. |
|
| Are you fluent in any language other than English?(*) |
yes
no
|
If so, which ones?
|
| List any skills you have relating to the job you are applying for(*). |
|
| List any computer skills you may have.(*) |
|
| List any special skills you may have. |
|
|
|
Please list 4 individuals not related to you who we might contact
for a work reference. Be sure to include the following for each: |
| Name #1 |
|
| Relationship | |
| Telephone number | |
| Name #2 |
|
| Relationship | |
| Telephone number | |
| Name #3 |
|
| Relationship | |
| Telephone number | |
| Name #4 |
|
| Relationship | |
| Telephone number | |
