Customer Service Representative Application Form

Personal Infomation
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

Availability and Pay
When can you start?*
Date Format: MM slash DD slash YYYY
Desired Wage?*
(Ex: $12.00/hr or $35,000/yr)
Are you a United States Citizen?*
- Yes
- No
- No, but I have proper documentation.
(If "No, but i have proper documentation" was selected we will ask to see all documentation for our records.)
Are you a United States Veteran?*
- Yes
- No

Education and Experience
What is your highest level of education?*
(We may ask for additional information such as details of graduation dates and degrees at a later time.)
Additional Education or Experience*
(Other skills, qualifications, or experience that we should consider such as current certifications, computer or program skills, pest control liceneses, etc...)

Work History & References
Do you have experience in an office environment?
- Yes
- No
(i.e. Receptionist, Paperwork Processing, etc...)
Company Information
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone Number
Date You Started
Date Format: MM slash DD slash YYYY
Date you Ended
Date Format: MM slash DD slash YYYY
Name of Supervisor
May We Contact Them?
- Yes
- No
Your Responsibilities
Your Reason for leaving
Have you worked at other companys?
- Yes
- No
Second Company Information
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company Phone Number
Date You Started
Date Format: MM slash DD slash YYYY
Date you Ended
Date Format: MM slash DD slash YYYY
Name of Supervisor
May We Contact Them?
- Yes
- No
Your Responsibilities
Your Reason for leaving
Personal References
(You must supply 3)
First Reference*
First Last
Phone*
Relationship*
Second Reference*
First Last
Phone*
Relationship*
Third Reference*
First Last
Phone*
Relationship*

Additional Information
Any additional information you feel we should know that has not been previously stated?*
Upload Your Resume
(If you have a resume please upload it so we may review)
I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. This company is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no supervisor, manager, or executive of this company, other than the president, has any authority to alter the foregoing.
I accept and understand the terms of this application as stated above and certify all information is correct to the best of my knowledge*
- I Agree
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Personal Infomation