Supervisor Civil

APPLICATION FOR EMPLOYMENT

CKJ Group is an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including race, color, age, sex, religion, national origin, the presence of mental, physical or sensory disability, sexual orientation or any other basis prohibited by federal and state Please complete entire application and supporting documents to ensure processing. PERSONAL INFORMATION (Please Print)

Last Name First Name Middle

Social Security Number Date of Application (M/D/Y) Are you less than 18 years of age?

YES NO

E-mail Address

Current Street Address City State Zip Code

Daytime Phone Number Evening Phone Number Referred By EMPLOYMENT DESIRED (If you are applying for an hourly position, please keep in mind that the availability of hours may vary) Position

Location/

Department Salary Desired Date You Can Start

Hours Available

for Each Day

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Are you able to work overtime?

YES NO

Are you legally eligible for employment in the U.S.? YES NO

(All new hires will be required to provide documentation to comply with I9 requirements.) Have you ever worked for CKJ Group?

YES NO

If yes, when? Which location?

Have you been convicted of a crime in the last seven (7) years? YES NO If yes, list convictions that are a matter of public record (arrests are not convictions). A conviction will not necessarily disqualify you for employment. CALIFORNIA APPLICANTS ONLY: applicant may omit any convictions for the possession of marijuana (except for convictions of the possession of marijuana on school grounds or possessions on concentrated cannabis that are more than two (2) years old, and any information concerning a referral to, and participation in, any pretrial; or post trial diversion program). MARYLAND APPLICANTS ONLY: Under Maryland law, an employer may not require or demand, as a condition of employment, prospective employment or continued employment, that an individual submit or take, a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100. MASSACHUSETTS APPLICANTS ONLY: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. Any employer who violates this law shall be subject to criminal penalties and civil liability. EDUCATION

Name and Address of School

Circle Last

Year

Completed Did You Graduate?

Subjects Studied

and Degrees

Received

High School 1 2 3 4 Y N

College 1 2 3 4 Y N

Post College 1 2 3 4 Y N

Trade, Business, or

Correspondence

School

1 2 3 4 Y N

List Skills relevant to the position applied for

FORMER EMPLOYERS - List below current and last three employers, starting with the most recent. Please include any non-paid/ volunteer experience which is related to the job for which you are applying. Please complete even if a resume is attached. DATE Current Employer (Name and Address) Salary Hourly If hourly, average hours per week: From

Starting Ending

To

Position Reason for Leaving

Duties Performed

Supervisor's Name Phone Number May we contact?

DATE Previous Employer (Name and Address) Salary Hourly If hourly, average hours per week: From

Starting Ending

To

Position Reason for Leaving

Duties Performed

Supervisor's Name Phone Number May we contact?

DATE Previous Employer (Name and Address) Salary Hourly If hourly, average hours per week: From

Starting Ending

To

Position Reason for Leaving

Duties Performed

Supervisor's Name Phone Number May we contact?

REFERENCES - Provide the names of three professional references whom you have known at least one year. Name Address and Phone Number Business

Years Acquainted /

How Do You Know

This Person?

1

2

3

I understand and agree that my employment is at will, which means that it is for no specified period and may be terminated by me or CKJ Group at any time without prior notice for any reason. I hereby authorize CKJ Group to thoroughly investigate my background, references, employment record and other matters related to my suitability for employment. I authorize persons, schools, my current employer (if applicable), and pervious employers and organizations contacted by CKJ Group to provide any relevant information regarding my current and/or previous employment and I release all person, schools, employers of any and all claims for proving such information. I understand that misrepresentation or omission of facts my result in rejection of the application, or of hired, discipline up to and including dismissal. I understand that I may be required to sign a confidentiality and/or non-compete agreement, should I become an employee of CKJ Group. I understand that nothing contained in the application, or conveyed during any interview which may be granted, is intended to create and employment contract. I understand that filling out this form does not indicate there is a position open and does not obligate CKJ Group to hire me. Date: Signature:

Contact this candidate