CHC's Employment Application Survey

Question Title

2. What CHC location are you applying for? (Required.)

Cabool

Houston

Marshfield

Rogersville

Question Title

3. What position are you seeking? (Required.)

Yard Staff

Driver (Requires Class B License or Higher)

Accounting/ Bookkeeping

Outside Sales

Retail Sales

Management

Question Title

4. Today's Date (Required.)

Date / Time

Date

Time

AM/PM

Question Title

5. Phone Number (Required.)

Question Title

6. Email Address (Required.)

Question Title

7. Your Address (Required.)

Street

City

State

Zipcode

Question Title

8. Have you ever used another name? If so, please state names and dates: (Required.)

Name 1

Date 1

Name 2

Date 2

Question Title

9. Salary: (Required.)

Salary Expected:

Least Expected:

Question Title

10. When could you start? (Required.)

Question Title

11. Part Time or Full Time (Required.)

Part Time

Full Time

Question Title

12. If you prefer part time, what days and hours would you be available? (Required.)

Days:

Hours:

Question Title

13. Do you have a close friend or family member who works at CHC? (Required.)

Yes

Question Title

14. How did you hear about the job you are applying for? (Required.)

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. (Required.)

Name 1 / Address / Occupation / Years Known / Telephone

Name 2 / Address / Occupation / Years Known / Telephone

Question Title

16. Education: High School (Required.)

Names of High School

Address

Number of Years Attended

Graduated (Yes or No)

Degree

GPA

Area of Specialization

Question Title

17. Education: College (Required.)

Name of College

Address

Number of Years Attended

Graduated? (Yes or No)

Degree

GPA

Area of Specialization

Question Title

18. Education: Other (Required.)

Graduate

Trade School

Apprenticeships

Other

Question Title

19. Military Service (Required.)

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 (Required.)

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 (Required.)

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 (Required.)

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 (Required.)

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? (Required.)

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) (Required.)

Question Title

26. Drivers License (Required.)

Drivers license #

State

Class

Expiration Date

Question Title

27. Is your drivers license currently suspended? (Required.)

Yes

Question Title

28. List any traffic convictions you have had in the last 24 months (required in order to to drive vehicle or equipment) (Required.)

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) (Required.)

Yes

Question Title

* 1. Full Name (Required.)

Question Title

* 2. What CHC location are you applying for? (Required.)

Question Title

* 3. What position are you seeking? (Required.)

Question Title

* 4. Today's Date (Required.)

Question Title

* 5. Phone Number (Required.)

Question Title

* 6. Email Address (Required.)

Question Title

* 7. Your Address (Required.)

Question Title

* 8. Have you ever used another name? If so, please state names and dates: (Required.)

Question Title

* 9. Salary: (Required.)

Question Title

* 10. When could you start? (Required.)

Question Title

* 11. Part Time or Full Time (Required.)

Question Title

* 12. If you prefer part time, what days and hours would you be available? (Required.)

Question Title

* 13. Do you have a close friend or family member who works at CHC? (Required.)

Question Title

* 14. How did you hear about the job you are applying for? (Required.)

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. (Required.)

Question Title

* 16. Education: High School (Required.)

Question Title

* 17. Education: College (Required.)

Question Title

* 18. Education: Other (Required.)

Question Title

* 19. Military Service (Required.)

Question Title

* 20. Work History #1 (Required.)

Question Title

* 21. Work History #2 (Required.)

Question Title

* 22. Work History #3 (Required.)

Question Title

* 23. Work History #4 (Required.)

Question Title

* 24. May we contact all your employers listed? (Required.)

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) (Required.)

Question Title

* 26. Drivers License (Required.)

Question Title

* 27. Is your drivers license currently suspended? (Required.)

Question Title

* 28. List any traffic convictions you have had in the last 24 months (required in order to to drive vehicle or equipment) (Required.)

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) (Required.)

1. Full Name (Required.)

2. What CHC location are you applying for? (Required.)

3. What position are you seeking? (Required.)

4. Today's Date (Required.)

5. Phone Number (Required.)

6. Email Address (Required.)

7. Your Address (Required.)

8. Have you ever used another name? If so, please state names and dates: (Required.)

9. Salary: (Required.)

10. When could you start? (Required.)

11. Part Time or Full Time (Required.)

12. If you prefer part time, what days and hours would you be available? (Required.)

13. Do you have a close friend or family member who works at CHC? (Required.)

14. How did you hear about the job you are applying for? (Required.)

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. (Required.)

16. Education: High School (Required.)

17. Education: College (Required.)

18. Education: Other (Required.)

19. Military Service (Required.)

20. Work History #1 (Required.)

21. Work History #2 (Required.)

22. Work History #3 (Required.)

23. Work History #4 (Required.)

24. May we contact all your employers listed? (Required.)

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) (Required.)

26. Drivers License (Required.)

27. Is your drivers license currently suspended? (Required.)

28. List any traffic convictions you have had in the last 24 months (required in order to to drive vehicle or equipment) (Required.)

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) (Required.)