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Last Name is Required.
First Name is Required.
First Name is Required.
Date is Required.
Phone number is Required.
Are you authorized to work in the U.S.?
This section is Required.
Do you now or will you in the future require sponsorship for employment visa status?
This section is Required.
Please Note: Upon employment you will be required to submit verification of your identity and your legal right to work in the United States.
Type of work desired?
This section is Required.
Will you accept shift work?
This section is Required.
How did you learn of this opening?

Education


U.S. Military


Employment Record




May we contact your present employer?
May we contact your previous employers?






Have you been convicted of a felony within the past seven years?
This section is Required.
APPLICANTS STATEMENT AND AGREEMENT
Read the following carefully before signing this application for employment.

I HEREBY CERTIFY THAT ALL THE ANSWERS ON THIS APPLICATION ARE CORRECT TO THE BEST OF MY KNOWLEDGE AND BELIEF. I UNDERSTAND THAT MISREPRESENTATION WILL BE CONSIDERED AS JUST CAUSE FOR REJECTION OF THIS APPLICATION OR DISMISSAL FROM EMPLOYMENT. I UNDERSTAND THAT NEITHER THIS APPLICATION NOR ANY COMMUNICATION BY A MANAGEMENT REPRESENTATIVE IS INTENDED TO CREATE A CONTRACT OF EMPLOYMENT, OFFER, OR PROMISE OF EMPLOYMENT. IF I AM OFFERED EMPLOYMENT, I UNDERSTAND THAT I WILL BE REQUIRED TO COMPLETE A PRE-PLACEMENT MEDICAL EXAM, DRUG SCREEN, AND BACKGROUND CHECK BEFORE BEGINNING WORK, IN WHICH CASE THE COMPANY’S OFFER OF EMPLOYMENT WILL BE CONDITIONED UPON SATISFACTORY COMPLETION OF THESE REQUIREMENTS.

Signature is Required.
Date is Required.


As a Government contractor, EHC is required to maintain specific data on the number, ethnicity, race and gender of applicants. To this end EHC requests that you complete the following applicable information. This information will be removed from the application form and retained by the Human Resources Department for record keeping purposes only. This information is completely voluntary and your response will not adversely affect your employment opportunities with CSI.

Gender
Ethnicity/Race


*not Hispanic or Latino



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