Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
SS#
*
Preferred Age Group
*
click as many as desired
Date Available to Start Working
*
MM
DD
YYYY
Preferred Days to Work
*
Desired Hourly Wage
*
Job Requirements
*
Check all that apply to you
Criminal History
*
Check all that applies to you
If you checked boxes 2 or 4 above
please type explanation in box below
Are you 18 or older
*
I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.
*
Educational Experience (share briefly below)
*
Type "None" if you have no past educational experience
Professional Experience (share briefly below)
*
Type "None" in you have no past professional experience
How did you find out about this job opening? (share below)
*
Professional Reference #1
(provide name, company & phone)
Professional Reference #2
(provide name, company & phone)
Disclaimer
*
By signing below, I hereby affirm that I have responded to all inquiries on this form fully and frankly, and all the information contained in my application is true and correct. I understand that any misrepresentation or falsification of any of the CKCA Application forms or documents may result in possible termination, or if the problem comes to light after hire, it can result in immediate dismissal from employment. I further consent and agree to submit to any job-related medical exams or drug tests that might be required and agree to provide any information that may be needed to facilitate such tests.
Signature
*
By typing my full name in the box below represents my official signature.
