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The Cuyahoga Group Application for Employment

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APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer

Last Name:

First Name:

Middle Initial:

Address:

City:

State:

Zip:

Phone Number:

Are you 18 years of age or older?
(Yes or No)

Emergency Contact Name:

Phone Number:

Do you have a valid drivers license?
If yes:

State:

Number:

Position Applied For:

Minimum Salary Required:

Are you willing to work (Yes or No):

	Full Time		Part Time
	Days		Nights
	Year Round		Seasonal
	Rotating Shifts		Temporary

What date would you be available for work?

Are you willing to travel?
(Yes or No)

Have you ever been employed with this company before?
(Yes or No)

Special skills or training that would be of benefit in the job for which you are applying?

Are you legally eligible for employment in the United States? If yes, proof is required upon acceptance of a position.
(Yes or No)

Have you ever been convicted of a felony? (Yes or No)
(Yes or No)

If yes, please explain:

EDUCATION BACKGROUND

School	Name/Location	Course of study	Did you graduate?
Grammar School			(Yes or No)
High School			(Yes or No)
College			(Yes or No)
Vocational Training/Other			(Yes or No)

EMPLOYMENT EXPERIENCE List most recent employer first.

Please indicate employer(s) you do not want us to contact.

Employer #1:

May we contact: (Yes or No)

Company Name:

Address:

City:

State:

Zip:

Phone Number:

Job Title:

Dates Employed:

From:

To:

Duties:

Supervisor:

Reason for Leaving:

Rate of Pay:

Starting:

Ending:

Employer #2:

May we contact: (Yes or No)

Company Name:

Address:

City:

State:

Zip:

Phone Number:

Job Title:

Dates Employed:

From:

To:

Duties:

Supervisor:

Reason for Leaving:

Rate of Pay:

Starting:

Ending:

Employer #3:

May we contact: (Yes or No)

Company Name:

Address:

City:

State:

Zip:

Phone Number:

Job Title:

Dates Employed:

From:

To:

Duties:

Supervisor:

Reason for Leaving:

Rate of Pay:

Starting:

Ending:

Employer #4:

May we contact: (Yes or No)

Company Name:

Address:

City:

State:

Zip:

Phone Number:

Job Title:

Dates Employed:

From:

To:

Duties:

Supervisor:

Reason for Leaving:

Rate of Pay:

Starting:

Ending:

PERSONAL REFERENCES (OTHER THAN FAMILY MEMBERS OR PREVIOUS EMPLOYERS)

Reference #1:

Name:

Address:

Phone Number:

Reference #2:

Name:

Address:

Phone Number:

Reference #3:

Name:

Address:

Phone Number:

Reference #4:

Name:

Address:

Phone Number:

THANK YOU FOR YOUR INTEREST IN OUR COMPANY.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements contained herein shall be grounds for termination.

I authorize investigation of all statements contained herein including the references from the employers listed above, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information.

I understand that nothing contained in this employment application or in the granting of an interview is intended to create a contract between me and The Cuyahoga Group for either employment or the provision of any benefits; and further understand that if an employment relationship is established, I will have the right to terminate my employment at any time and the company will have a similar right. If hired, there is a 90 day probationary period. In addition, I understand that no promise, representation or agreement contrary to the foregoing is binding in the company unless made in writing and signed by me and an authorized officer of the company.

If I am hired to drive a company vehicle, I understand that any offer of employment is contingent upon acceptance of my driver’s license Motor Vehicles Report by the Company’s insurance carrier.

If necessary, I understand that any offer of employment is contingent upon obtaining a negative drug screening result within 72 hours of employment. Should I terminate my employment with The Cuyahoga Group in less than 90 ninety days of my hire date, I agree to have the cost of the pre employment drug screening and criminal background check deducted from my final pay check.

The Cuyahoga Group does not discriminate in hiring or employment on the basis of race, color, religious creed, national origin, sex, age, handicap or veteran status. No question on this application is intended to secure information to be used for such discrimination.

PLEASE BE SURE TO:

INDICATE THAT YOU HAVE READ AND UNDERSTAND THE ABOVE. (Yes or No)

DATE THIS APPLICATION:

The Cuyahoga Group
Toll Free (800) 901-8363 • Local (216) 663-1457 • (216) 663-1456 fax

Franklin Services
Toll Free (800) 686-9455 • Local (614) 863-8700 • (614) 482-8100 fax

Info@cuygroup.com

APPLICATION FOR EMPLOYMENT An Equal Opportunity Employer

APPLICATION FOR EMPLOYMENT
An Equal Opportunity Employer