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CHC's Employment Application
*
1.
Full Name
(Required.)
*
2.
What CHC location are you applying for?
(Required.)
Cabool
Houston
Marshfield
Rogersville
*
3.
What position are you seeking?
(Required.)
Yard Staff
Driver (Requires Class B License or Higher)
Accounting/ Bookkeeping
Outside Sales
Retail Sales
Management
*
4.
Today's Date
(Required.)
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Hour
Time
:
Minutes
AM/PM
-
AM
PM
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5.
Phone Number
(Required.)
*
6.
Email Address
(Required.)
*
7.
Your Address
(Required.)
Street
City
State
Zipcode
*
8.
Have you ever used another name? If so, please state names and dates:
(Required.)
Name 1
Date 1
Name 2
Date 2
*
9.
Salary:
(Required.)
Salary Expected:
Least Expected:
*
10.
When could you start?
(Required.)
*
11.
Part Time or Full Time
(Required.)
Part Time
Full Time
*
12.
If you prefer part time, what days and hours would you be available?
(Required.)
Days:
Hours:
*
13.
Do you have a close friend or family member who works at CHC?
(Required.)
Yes
No
*
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.)
Name 1 / Address / Occupation / Years Known / Telephone
Name 2 / Address / Occupation / Years Known / Telephone
*
16.
Education: High School
(Required.)
Names of High School
Address
Number of Years Attended
Graduated (Yes or No)
Degree
GPA
Area of Specialization
*
17.
Education: College
(Required.)
Name of College
Address
Number of Years Attended
Graduated? (Yes or No)
Degree
GPA
Area of Specialization
*
18.
Education: Other
(Required.)
Graduate
Trade School
Apprenticeships
Other
*
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
*
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
*
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
*
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
*
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
*
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.)
Drivers license #
State
Class
Expiration Date
*
27.
Is your drivers license currently suspended?
(Required.)
Yes
No
*
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
Date/ Violation
Date/ Violation
Date/ Violation
Date/ Violation
*
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
No
