Employment Application Pre-employment questionnaire. Equal opportunity employer. Personal InformationName(Required) First Middle Initial Last Address 1(Required)Address 2City(Required)State(Required)KansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code(Required)Phone(Required)Alternate PhoneEmail(Required) AvailabilityPosition Applying For(Required)Are you employed now? Yes No May we contact your current employer? Yes No Current EmployerDate Availalble to Start Work MM slash DD slash YYYY Salary DesiredType of position desired: (Select all that apply)(Required) Full-Time Part-Time Seasonal Shift Desired(Required) Any Days Evenings Weekends Have you ever been employed by us? Yes No If yes, when?Do you have relatives that work for CM3? Yes No Relative's NameRelationship to RelativeRelative's position at CM3Are you authorized to work in the U.S.?(Required) Yes No Have you been convicted of a felony or misdemeanor crime in the last 7 years?(Required) Yes No Please provide details…(Required)List any certifications / trade licenses:Do you have a valid Kansas driver's license? Yes No Are you a licensed Kansas CDL driver? Yes No How did you hear about us? School Current / Former Employee Referral Internet Temp Service Walk-In Other Education High SchoolSchool NameAddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodeGraduated? Yes No Number of Years Completed CollegeSchool NameAddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodeGraduated? Yes No Number of Years CompletedMajor (if applicable) Trade/Technical/Other SchoolSchool NameAddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodeGraduated? Yes No Number of Years CompletedSubject of study? Other TrainingUS Military ServiceRankList any skills or additional training you think might be helpful to your application.Work History Start with your present or most recent job, include military service assignments and volunteer activities. Employer OneName of EmployerJob TitleDate Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY AddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodePhoneSupervisor NameType of Job Full Time Part Time Seasonal Beginning SalaryEnding SalarySummary of DutiesReason for LeavingEmployer TwoName of EmployerJob TitleDate Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY AddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodePhoneSupervisor NameType of Job Full Time Part Time Seasonal Beginning SalaryEnding SalarySummary of DutiesReason for LeavingEmployer ThreeName of EmployerJob TitleDate Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY AddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodePhoneSupervisor NameType of Job Full Time Part Time Seasonal Beginning SalaryEnding SalarySummary of DutiesReason for LeavingEmployer FourName of EmployerJob TitleDate Started MM slash DD slash YYYY Date Ended MM slash DD slash YYYY AddressCityStateKansasAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodePhoneSupervisor NameType of Job Full Time Part Time Seasonal Beginning SalaryEnding SalarySummary of DutiesReason for LeavingReferences Give the names of three persons not related to you, whom you have known for at least one year, and are willing to discuss your work performance. Reference OneNameTitleCompanyYears KnownPhoneEmail Reference TwoNameTitleCompanyYears KnownPhoneEmail Reference ThreeNameTitleCompanyYears KnownPhoneEmail Upload ResumeFileAccepted file types: pdf, jpg, jpeg, Max. file size: 5 MB.Acknowledgement and Agreement Please read before confirming. CM3, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without illegal discrimination because of race, color, religion or creed, sex/gender, nation origin or ancestry, citizenship, protected veteran or disabled status, age, disability/handicap, genetic information, marital status, or any other characteristics protected by law. I understand and acknowledge that any employment relationship with CM3, Inc. is “at will” which means that I may resign at any time and that the Company may terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the Company has the authority to make any assurances to the contrary. I certify that all statements on this application are true and complete and that I have not withheld any information which would, if disclosed, affect this application unfavorably. Omitted information or false information provided on this application form or during the interview will be sufficient cause for cancellation of this application and/or termination from employment. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. BY CHECKING THE BOX BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS.I have read the Acknowledgement and Agreement Statement(Required) ConfirmNameThis field is for validation purposes and should be left unchanged.
