Application for Employment

Application for Employment
Position Applied For:*
Today's Date*

MonthDayYear
Date
Please define position:
Applicant Information:
Last Name*
First Name*
Middle Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone*
Home Phone
Email Address*
example@example.com
Are you currently under contract?

YesNo
If Yes, where:
Date Available to Start

MonthDayYear
Date
Are you eligible to work in the US without sponsorship?*
Have you ever worked for CMC or any of its programs before?*

YesNo
If Yes, which program and provide dates of employment:
How did you hear about CMC?
Education and Certification/License Information:
Highest Degree conferred:*
Credits Beyond Degree
Name of School:
List any current Certifications or Licenses:
Cert/License Title
Number
Date awarded

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Cert/License Title
Number
Date awarded

MonthDayYear
Date
Expiration Date

MonthDayYear
Date
Work History

Please list your work experience beginning with your most recent job. If you were self-employed, give a firm name. Attach additional sheets if necessary.
Most Recent Employer:*
Dates Employed From:

MonthDayYear
Date
To:

MonthDayYear
Date
Work performed:
Address of Employer:
Supervisor Name:
Job Title:*
Reason for leaving:
May we contact?*

YesNo
Employer #2
Date Employed From:

MonthDayYear
Date
To:

MonthDayYear
Date
Work performed:
Address of Employer:
Supervisor Name:
Job Title:
Reason for leaving:
May we contact?

YesNo
Employer #3:
Date Employed From:

MonthDayYear
Date
To:

MonthDayYear
Date
Work performed:
Address of employer:
Supervisor:
Job Title:
Reason for leaving:
May we contact?

YesNo
References

Please provide 3 professional references including at least 1 supervisor.
Name of Reference #1:*
Position:
Employer:
Address:
Telephone:
Format: (000) 000-0000.
Email:
example@example.com
Was this person your supervisor?

YesNo
Was this person your co-worker?

YesNo
Name of Reference #2:*
Position:
Employer:
Address of Employer:
Telephone:
Format: (000) 000-0000.
Email:
example@example.com
Was this person your supervisor?*

YesNo
Was this person a co-worker?

YesNo
Name of Reference #3:
Position:
Employer:
Address of employer:
Telephone:
Format: (000) 000-0000.
Email:
example@example.com
Was this person a supervisor?

YesNo
Was this person a co-worker?

YesNo
Language Skills:
● Fluent - Applicant has a comprehensive understanding of all words, concepts, and nuances of the language.

● Moderate - Applicant can conduct a conversation (either spoken or written) and effectively communicate, understanding the vast majority of words and concepts.

● Basic - Applicant understands some or many words and concepts.

Speaking: applicant can communicate using the language and visual aides.

Reading: applicant can identify some words and themes.

Writing: applicant can communicate with simple words and phrases.

● None - Applicant has no skill with the ability

Language Skills

Rows	Language	Speaking	Reading	Writing
Language 1
Language 2
Language 3
Language 4

List any other special skills or interests you have:
Please attach the following documents:
- Official transcripts or degree
- Resume
- License(s)
- Certification(s)
Upload documents here:

Cancelof
Applicant statement and Authorization:

"I certify that the facts contained in my application and any additional materials submitted are true and complete to the best of my knowledge. I understand that intentional falsification of statements, incomplete or misleading information on this application or additional material will result in the automatic removal of my application from further employment considerations, and, if employed, shall be grounds for immediate dismissal. When it is determined that an employee or prospective employee failed to disclose or fully disclose his or her background through misunderstanding or inadvertence, I understand that such failure will be considered a significant factor in employment or termination considerations."

"If employed, I also understand that although my employment may commence prior to the completion of the criminal records check process, continued employment would be contingent upon a satisfactory criminal records check."

"I authorize investigation of all statements contained herein. I also give permission to the references and previous employers listed on the application and any attachments to provide to you and any and all information concerning my employment and any other pertinent information they may have. I agree to release all parties from all liability for any damage that may result from furnishing such information to you."

"I understand that, if offered the position, I will be required to verify my employment eligibility as required by law, including the completion of an I-9 Form."
Signature of Applicant*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Application for Employment

Applicant Information:

Education and Certification/License Information:

Work History

References

Language Skills: