At CCS it's all about our people.

Name:*

Last 4 digits from SSN:*

Any other names you worked under?

Address:

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennslyvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Phone Number:

Email:*

Desired Salary:

Position Applied for:

How did you hear about this job?

Tell us the reason you left your previous employment:

Are you authorized to work in the United States?

YesNo

Have you ever worked for this company?

YesNo

If so, when?:

Have you ever been convicted of a felony?

YesNo

If yes, explain:

Please attach a cover letter and resume (2MB max PDF file).

High School:

From Date:

To Date:

Did you graduate?

YesNo

College:

From Date:

To Date:

Did you graduate?

YesNo

Please list three professional references.

Reference #1

Reference #2

Reference #3

Need 7 years of employment history. Explain any gaps in employment.

Employment #1

Phone Number:

Employment Start Date:

Employment End Date:

Address:

Job Title:

Start Salary:

End Salary:

Responsibilities:

Supervisor Name:

Supervisor Phone Number:

May we contact your previous employer?

YesNo

Employment #2

Phone Number:

Employment Start Date:

Employment End Date:

Address:

Job Title:

Start Salary:

End Salary:

Responsibilities:

Supervisor Name:

Supervisor Phone Number:

May we contact your previous employer?

YesNo

Employment #3

Phone Number:

Employment Start Date:

Employment End Date:

Address:

Job Title:

Start Salary:

End Salary:

Responsibilities:

Supervisor Name:

Supervisor Phone Number:

May we contact your previous employer?

YesNo

Branch:

From Date:

To Date:

Rank at Discharge:

Type of Discharge:

If other than honorable, explain:

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.