CANDIDATE INFORMATION

Legal Full Name:

Address: , ,

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How Did You Hear About CPS?

Position Desired:

Date Available to Start Work:

Salary Desired:

If unavailable to work certain days/hours, please explain:

Briefly tell us about yourself, your ambitions, qualifications, and reasons for seeking employment with our company:

EMPLOYMENT HISTORY

EMPLOYMENT HISTORY #1

Employer Name:

Address:

Telephone Number:

Supervisor Name:

Position Held:

Dates Employed: to

Specific Duties:

Reason for Leaving:

EDUCATION & SKILLS

Last High School Attended:

Location of School:

Last College Attended:

Location of School:

College Gaduate Work:

Location of School:

Busines Trade School:

Location of School:

Other

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Are you under 18 years of age?

Have you ever been employed by our Company?

Are you related to an Employee, Officer or Director of the Corporation?

Summarize special skills and qualifications acquired from employment, membership in professional organizations or other experiences that may qualify you for work with our Company. Exclude those which indicate race, color, religion, gender, national origin, ancestry, age, physical or mental disability, medical condition, sexual orientation, marital or veteran status:

Supplemental Resume:

ACKNOWLEDGEMENTS

If offered a position, can you submit verification of your legal right to work in the United States within 3 working days from your first day of employment?

Are you employed now?

By clicking this box, typing my full name and selecting the "Submit Completed Application" button below, I hereby certify that all of the forgoing information I have supplied in this application is true and complete. I understand that any misrepresentation, falsification or omission of information may result in the denial of employment or, if hired, may result in immediate termination. I give the Company permission to contact any or all of my previous employers and references for full information and hereby release the Company from any and all liability.

If employed, and in consideration of my employment, I agree to conform to the rules, procedures and policies of the Company. I understand that nothing contained within this application, or in the Company's granting one or more interviews, will create an employment relationship between the Company and me. If I accept employment with the Company, I understand that my continued employment will be based on the results of a background investigative report. If I am hired, my employment will be at-will. My employment and compensation can be terminated without cause or notice, for any reason, at any time, at the option of either the Company or me. I further understand that no management representative of the Company, except the President, has any authority to enter into any agreement contrary to the of at-will employment.

I acknowledge that I have read all of the above statements and that I understand them.

NAME OF APPLICANT:           DATE: