Name *
Address *
Phone *
Available Start Date *
Available Start Date
Do you have a valid drivers license? *
Are you authorized to work and remain in the United States? *
Were you ever discharged or forced to resign from any position? *
Have you ever been employed by C&S Supply? *
Are you related to any C&S Supply Employee? *
Are you a High School Graduate? *
High School Equivalency? *
Are you presently attending school? *
Did you graduate? *
Do you have additional education to enter? *
Employment History
Beginning with your present or most recent experience, account for all employment during the past two (2) years. To elaborate, a supplemental sheet or resume may be attached, but cannot be substituted for a completed application. Include military service if applicable.
Phone 1 *
Phone 1
Previous employers phone number
Previous Employer's Address *
Previous Employer's Address
Supervisor Name *
Supervisor Name
Date Started *
Date Started
Date Ended *
Date Ended
May we contact your present employer? *
Personal References
Personal Reference Full Name *
Personal Reference Full Name
Personal Reference Address *
Personal Reference Address
Reference's Phone Number *
Reference's Phone Number
APPLICANT’S STATEMENT AND AUTHORITY TO RELEASE INFORMATION (Required for ALL Positions)I understand that this employment application and any other documents are not contracts of employment, and any person hired may be terminated by the employer at any time for any reason. I understand that any oral or written statements to the contrary are expressly disavowed and should not be relied upon by a prospective or existing employee. I understand that C&S Supply may modify, change, or revoke any of its employment policies,pay practices, and benefits without my agreement. I hereby state that all answers on this application are true and understand that falsifying this information can lead to termination if hired. I hereby authorize any and all persons, companies, or agencies to release any and all background information, of a confidential or privileged nature,including criminal history, relevant to this application and any pertinent information they may have to the hiring authorities of C&S Supply. I release all such parties from all liability of every kind as the result of furnishing the same to C&S Supply. This information is to be used to assist the C&S Supply in determining my qualifications and fitness for the position I am seeking. I hereby release C&S Supply and its officers, agents and employees from any liability for the use of any and all of the foregoing information, in consideration for being reviewed for the aforesaid position.
Today's Date *
Today's Date
Your Full Name *
Your Full Name
How did you hear about this position?