CHC's Employment Application Question Title * 1. Full Name Question Title * 2. What CHC location are you applying for? Cabool Houston Marshfield Rogersville Question Title * 3. What position are you seeking? Yard Staff Driver (Requires Class B License or Higher) Accounting/ Bookkeeping Outside Sales Retail Sales Management Question Title * 4. Today's Date Date / Time Date Time AM/PM - AM PM Question Title * 5. Phone Number Question Title * 6. Email Address Question Title * 7. Your Address Street City State Zipcode Question Title * 8. Have you ever used another name? If so, please state names and dates: Name 1 Date 1 Name 2 Date 2 Question Title * 9. Salary: Salary Expected: Least Expected: Question Title * 10. When could you start? Question Title * 11. Part Time or Full Time Part Time Full Time Question Title * 12. If you prefer part time, what days and hours would you be available? Days: Hours: Question Title * 13. Do you have a close friend or family member who works at CHC? Yes No Question Title * 14. How did you hear about the job you are applying for? Question Title * 15. List 2 people that have known you at least 1 year that we may contact. Do not include relatives, former employers, or personnel of this company. Name 1 / Address / Occupation / Years Known / Telephone Name 2 / Address / Occupation / Years Known / Telephone Question Title * 16. Education: High School Names of High School Address Number of Years Attended Graduated (Yes or No) Degree GPA Area of Specialization Question Title * 17. Education: College Name of College Address Number of Years Attended Graduated? (Yes or No) Degree GPA Area of Specialization Question Title * 18. Education: Other Graduate Trade School Apprenticeships Other Question Title * 19. Military Service Branch of Service Dates of Service Reserve Status Rank at Separation Type of Separation Length of Service (Months) Present Classification Principle Work Duties Question Title * 20. Work History #1 Company Name Address Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 21. Work History #2 Company Name Address Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 22. Work History #3 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 23. Work History #4 Company Name Address Phone Date Started Date Ended Job Title Name and Title of Supervisor Reason for Leaving Rate of Pay Duties Question Title * 24. May we contact all your employers listed? Question Title * 25. Have you ever been convicted of, pleaded no contest to, or received a suspended imposition of sentence for a felony by any court or law (Federal, State, Military, Local)?(Note: Conviction for a felony will not necessarily disqualify you from employment with CHC) Question Title * 26. Drivers License Drivers license # State Class Expiration Date Question Title * 27. Is your drivers license currently suspended? Yes No Question Title * 28. List any traffic convictions you have had in the last 24 months (required in order to to drive vehicle or equipment) Date/ Violation Date/ Violation Date/ Violation Date/ Violation Date/ Violation Question Title * 29. Are you legally eligible to work in the United States? (The law requires you to provide us with proof of authorization for employment in the U.S. within 3 days of your hire date) Yes No NEXT
