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Applicant Information

If you are under 18, can you provide a work permit?

Have you applied with CentralStar before?

Are you legally eligible for employment in the U.S.?

(Proof of U.S. Citizenship or Immigration Status may be required upon employment)

Date available for work

Type of employment desired:

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Are you currently on layoff and subject to recall?

Will you relocate if the job requires it?

Will you travel if the job requires it?

Are you able to meet the attendance requirements for the position?

Will you work overtime if needed?

Have you ever been bonded?

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

Please send a confidential email to [email protected], Director of Human Resources. Include the date of final disposition of the case and the nature of the offense. This information does not automatically disqualify you from employment but false or misleading information will. Factors such as job relevance, age and time since the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

Employment History

Beginning with the most recent.

Employer

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Supervisor

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Ending Salary

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Responsibilities

Do you have a non-compete or other employment agreement with this employer?

May we contact this employer?

Would you like to add another job?

Employer

Employer Phone

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Title

Starting Salary

Ending Salary

Reason for leaving

Responsibilities

Do you have a non-compete or other employment agreement with this employer?

May we contact this employer?

Educational Background

Name of High School

Degree / Diploma Received?

Name of College

Degree / Diploma Received?

Field of Study

Number of years completed

Technical School

Degree / Diploma Received?

Field of Study

Number of years completed

Other Training

Language Skills

Please list languages you speak.

Skill Level in that language

Speak Some
Speak Fluently
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Write

Work-related References

List information for business/work references that are NOT related to you and are not previous supervisors. If not applicable, list three school or personal references not related to you.

Reference 1 Name

Reference 1 Occupation

Reference 1 Years Known

Reference 1 Phone or Contact Information

Reference 2 Name

Reference 2 Occupation

Reference 2 Years Known

Reference 2 Phone or Contact Information

Reference 3 Name

Reference 3 Occupation

Reference 3 Years Known

Reference 3 Phone or Contact Information

Other information

Skills and Qualifications

Summarize any special training, skills, licenses, and/or certifications that may qualify you as being able to perform the job-related functions of the position for which you are applying.

Professional Organizations

List professional, trade, or business associations relevant to the position you’ve applied for including offices held.

List other accomplishments, publications and awards.

List any other information you would like us to consider that is relevant to this position.

CentralStar Cooperative, Inc. Statement

CentralStar Cooperative, Inc. is an Equal Opportunity Employer and does not discriminate in employment. No question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law. It is also CentralStar Cooperative, Inc.’s policy not to refuse to hire a qualified individual with a disability because of a need for reasonable accommodation as required by the ADA. This application is current and active for a period of 60 days. At the conclusion of this time, if you have not heard from CentralStar Cooperative Inc. and still wish to be considered for employment, it will be necessary to submit a new application.*

I have read the above statement

Applicant's Statement

Please read this statement carefully before submitting this application.

I understand that as an at-will employee, I am free to resign at any time just as CentralStar Cooperative reserves the right to terminate my employment at any time, with or without cause and without prior notice as is consistent with applicable state or federal law. I understand that no representative of the employer has the authority to make any assurances to the contrary. I authorize CentralStar Cooperative, Inc. 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 CentralStar Cooperative, Inc., 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 attest that I am not restricted by a signed contract or other agreement with former employers which include provisions that could preclude, prohibit or restrict the terms and conditions of my employment with CentralStar Cooperative, Inc. without having fully disclosed and provided a copy of said document to CentralStar Cooperative, Inc. prior to any offer of employment. I understand it is my responsibility to honor and comply with any outstanding agreements and to make CentralStar Cooperative, Inc. aware of their existence. This includes but may not be limited to non-compete agreements, non-solicitation agreements, and/or restrictive covenants.*

I certify that all the statements in this completed application are true and understand that any falsification, misrepresentation, or willful omission shall be sufficient cause for cancellation of this application, including refusal to hire, and/or termination of employment if I have been employed.

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Employment Application

Applicant Information

Employment History

Educational Background

Language Skills

Work-related References

Other information

CentralStar Cooperative, Inc. Statement

Applicant's Statement