Career Application

Name*

First Last

Prior Name

Email*

Phone

Address*

Street Address City State / Province / Region ZIP / Postal Code

Date Available for Employment

Desired Salary*

Are you willing to work Overtime*

(Over 40 hours per week)

Yes

No

Computer Skills

List applications you have experience with

Other Job Related Skills

Position applying for:*

Are you applying for*

Full Time

Part Time

Flex Tim

Temporary

How were you referred to CNOS?*

Have you ever been employed by CNOS?*

Yes

No

Position

Department

Start Date

End Date

Are you willing to provide necessary documentation to establish your identity and your authorization to work in the United States under Immigration Reform and Control Act of 1986?*

Yes

No

After reviewing the essential functions of the job for which you are applying, are you able to perform these essential functions with or without an accommodation?*

Yes

No

If you can perform the functions with an accommodation(s), please explain how you would perform the functions and with what accommodation(s)

Do you have any commitments to another employer that might affect your employment with us? Please explain*

Since reaching age 18, have you ever been convicted of a misdemeanor or felony? (Note: Convictions will not necessarily bar you from employment but are reviewed as related to the relevancy of the job for which you have applied)*

Yes

No

Please Explain

Year

County

Previous Employment

Previous Employer*

Position*

Address*

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

Reason For Leaving

Duration

Salary

Please list your previous employers*

List the most recent first.

Previous Employer

Position

City/State

Reason For Leaving

Duration

Salary

Has notice been given to present employer?

Yes

No

May we run an employment check from the employers listed above?

Yes

No

Have You Served in the Military?*

Yes

No

From

To

Highest Rank Obtained

Branch of Service

Additional Information

List any other country, state and city in which you have lived during the past 7 years.

List

City and State

Country

Year

Please include any information you think would be helpful to use in considering you for employment, such as additional work experience, publication, activities, accomplishments, etc.

You may exclude all information indicative of age, sex, religion, color

References

List*

Name

Title/Occupation

Company/Address

Phone Number

Education

HS/College/University*

School Name and Address

Course of Study

Degree or Diploma

Last Year Completed

Did You Graduate?

Yes

No

Professional License / Certificate

Professional License / Certificate*

Type

State

Expiration Date

Registration Number

Consent

Agreement*

I hereby affirm that the information provided on this application, (and accompanying resume, if any), is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. I understand that my employment can be terminated, with or without cause, at any time at the discretion of the employer or myself. I understand that no management official of the employer, other than the Chief Executive Officer of the employer, has any authority to enter into any agreement contrary to the foregoing or to make any oral assurance or promise of continued employment to me. I authorize person, schools, my current employer (if applicable), and previous employers and organizations named in this application (and accompanying resume, if any), to provide any relevant information that may be required to arrive at an employment decision.

I agree

Please Read Carefully Before Signing This Application

I authorize the Company to investigate all statements in this application and to secure any necessary information from all my employers and references. I hereby release all of those employers and references, and the Company from any and all liability arising from their giving or receiving information about my employment history, my academic credentials or qualifications, and my suitability for employment with the Company. I also authorize the Company to secure financial,credit and background information through an appropriate agency. I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my credit, academic credentials, employment references and drug screen. I further understand that any false or misleading statements will be sufficient cause for rejection of my application if the Company has not employed me and for immediate dismissal if the Company has employed me. I also authorize the Company to supply information about my employment record, in whole or in part, in confidence to any prospective employer, government agency, or other party having a legal and proper interest, and I hereby release the Company from any and all liability for its providing this information. In the event of my employment with the Company, I will comply with all rules, regulations, and policies set forth in the Company's policy manual or other communications distributed by the Company. I understand that nothing in this employment application, in the Company's policy statements or personnel guidelines or in my communications with any Company official is intended to create an employment contract between the Company and me. I also understand that the Company has the right to modify its policies without giving me any notice of the changes. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless it is made in writing and signed by a Company officer. I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. I also understand that the Company retains the right to terminate my employment at any time for any reason. I hereby acknowledge that I have read and understand the preceding statement.

Fair Credit Reporting Act Consumer Report Disclosure

As required by the Fair Credit Reporting Act, this is to advise you that, in connection with your application for employment with CNOS, PC, a consumer report regarding your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living, may be obtained with respect to you for employment purposes for a consumer reporting agency. I hereby authorize CNOS, PC, to obtain and use a consumer report with respect to me for employment purposes.

Signature*

Date*