Employment Application

INTRODUCTORY INFORMATION

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

APPLICANT QUESTIONS

Type of work desired:

Salary Desired:(Required)

Email(Required)

Date Available

Are you 16 years of age or older?

Yes

How were you referred to Cantu Services, Inc.?(Required)

Have you ever been convicted of, or pled guilty or no contest to, a crime other than a minor traffic violation?

Yes

If yes, please explain in detail on a separate attachment and include the date of final disposition of the case and the nature of the offense. This information will not necessarily disqualify you from employment but false or misleading information will. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

EDUCATION - High School or Last Grade Completed

Name & Address of School:

Courses of Study:

Number of years completed:

Degree/Diploma:

EDUCATION - College or Technical School

Name & Address of School:

Courses of Study:

Number of years completed:

Degree/Diploma:

EDUCATION - Other Schooling or Training

Name & Address of School:

Courses of Study:

Number of years completed:

Degree/Diploma:

MILITARY EXPERIENCE

Branch of Service

Service Start Date:

Service End Date:

Rank/Type of Service:

Job-Related Training/Experience:

RECORD OF EMPLOYMENT - EMPLOYER #1

List positions starting with most recent.

Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position Title

Supervisor

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

RECORD OF EMPLOYMENT - EMPLOYER #2

Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position Title

Supervisor

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

RECORD OF EMPLOYMENT - EMPLOYER #3

Employer

Phone

Address

Street Address Address Line 2 City State ZIP Code

Position Title

Start Date

End Date

Beginning Salary

Ending Salary

Duties

Reason for Leaving

WORK-RELATED REFERENCES:

Do not include relatives.

Reference #1 Name

Occupation

Years Known

Contact Info

Reference #2 Name

Occupation

Years Known

Contact Info

Reference #3 Name

Occupation

Years Known

Contact Info

STATEMENT

Please read the statement below carefully before agreeing and submitting.

Check this box to agree.

I understand that employment with Cantu Services, Inc. (the Organization) is at-will, meaning that I or the Organization may terminate my employment at any time, or for any reason consistent with applicable state or federal law, I authorize the Organization to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I hereby release the Organization, and its representatives or agents, from any liability that might result from such an investigation. I authorize all individuals, schools, and firms named to provide any requested information and release them from all liability for providing the requested information. I understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification or willful omission shall be sufficient cause for dismissal or refusal to hire.

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