Submit an application for employment at Cervs.Employment Application FEDERAL LAW REQUIRES US TO PROVIDE REASONABLE ACCOMODATIONS TO THE KNOWN DISABILITIES OF APPLICANTS AND EMPLOYEES UNLESS TO DO SO WOULD POSE AN UNDUE HARDSHIP. PLEASE LET US KNOW IF YOU NEED AN ACCOMODATION TO COMPLETE THE APPLICATION PROCESS OR TO PERFORM ANY ESSENTIAL ELEMENTS OF THE POSITION SOUGHT.Applicants are considered for all positions, and employees are treated during employments, without regard to race, color, religion, sex, national origin, age, disability or any other prohibited basis of discrimination, as provided under applicable state and federal law. Date of Application Position(s) Applied For Referral Source Advertisement Friend Relative Walk-In Employment Agency OtherOther First Name * Middle Name Last Name * Address * City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Phone * Email * Have you filed an application here before? * Yes No If yes, give date Have you ever been employed here before? * Yes No If yes, give date Are you employed now? * Yes NoMay we contact your present employer? * Yes NoAre you prevented from lawfully becoming employed in this country? * Yes NoIf hired, you will be required to submit documents to establish employment authorization and identity in compliance with the Immigration Reform and Control Act of 1986. While you need not provide this proof of citizenship or immigration status at the time you are interviewed, please be prepared to assure us that you can so immediately upon being hired. What date would you be available for work? * Expected Salary $Are you able to work * Full Time Part Time TemporaryWhat days? * Sunday Monday Tuesday Wednesday Thursday Friday SaturdayAre you on lay-off and subject to recall? * Yes NoHave you been convicted of a felony with the last 7 years? * Yes No If yes, please explain. (Convictions will not necessarily disqualify applicant from employment.) The recency, severity and pertinence of the conviction will all be considered. Are you a veteran of the US Military Service? Yes No If yes, what branch? List professional, trade, business or civic activities and offices held. (You may exclude those which indicate race, color, religion, sex or national origin.) REFERENCESGive name, address and telephone number of three (3) references who are not related to you and are not previous employers. Name Address Phone Add RemoveEDUCATIONPlease list education or specialized experience which relates to the position(s) you are applying. Exclude names and terms which indicate, for example, race, color, religion, sex, disability or national origin.Years Completed: Elementary School 4 5 6 7 8Years Completed: High School 9 10 11 12Years Completed: College/University 1 2 3 4Years Completed: Graduate/Professional 1 2 3 4 Diplomas/Degree Name of School Add RemoveTRAINING/ACTIVITIESDescribe Specialized Training, Apprenticeship Skills and Extra-Curricular Activities Training/Activity Name Location Length of Course Was Course Completed? Yes No Subject Other Add Remove Honors Received Special Skills and Qualifications, including those acquired from employment or other experience: EMPLOYMENT EXPERIENCEStart with your present or last job. Include military service assignments and volunteer activities. Exclude organization names which indicate, for example, race, color, religion, sex, disability or national origin. Employer Name Phone Number Address Job Title Supervisor Work Performed Reason for Leaving Start Date End Date Starting Hourly Rate/Salary Ending Hourly Rate/Salary Add RemoveAPPLICANT STATEMENT * These answers are true and complete to the best of my knowledge. The Company may investigate all statements contained in this application, and I understand that any False or misleading information provided may result in my immediate discharge, if hired. I UNDERSTAND THAT THIS APPLICATION IS NOT A CONTRACT OF EMPLOYMENT AND THAT IF HIRED, REGARDLESS OF ANY ORAL REPRESENTATIONS TO THE CONTRARY, THE EMPLOYMENT RELATIONSHIP BETWEEN MYSELF AND THE COMPANY IS TERMINABLE-AT-WILL. ANY CHANGES IN THIS EMPLOYMENT RELATIONSHIP MUST BE MADE IN WRITING. * I also understand that any offer of employment may be conditioned upon a health evaluation by a doctor selected by the Company, to determine whether I can perform the job duties. In addition, I understand a drug or alcohol test may be required depending upon Company policy. I authorize the Company to make a thorough investigation of my past employment, education and job-related activities, and I release from all liability all persons, companies, and corporations supplying such information. I also indemnify this Company against any liability which might result from making such investigations. * Additionally, I authorize the Company to supply my employment record, at its sole discretion, in whole or in part, to any prospective employer, government agency or other party, with an interest that the Company deems appropriate. If you are human, leave this field blank. Review
