Application for Employment:

Join the CTi team and take charge of your future!
Please complete the information requested.
Incomplete Applications will not be considered.
Personal Information

First Name
Last Name
Street Address
Address 2

City State Zip
Home Phone Work Phone

Social Security # Email
Where did you hear of CTi?

Have you ever been convicted of a criminal offense (felony or misdemeanor)? (Convictions for marijuana-related offenses that are more than two years old need not be listed.) If yes, state the nature of the crime(s), when and where convicted, and disposition of the case. Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense, the surrounding circumstances, and the relevance of the offense to the position(s) applied for may, however be considered.)

 Yes No
     
Do you currently posses any student loan(s) that are in default status? Yes No
Are you at least 18 years old? (If under18, hire is subject to verification that you are of legal minimum age.) Yes No
If hired can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No

Do you have any friends or relatives working for CTi? If yes, state name(s) and relationship.

Name Relationship

Name Relationship

Yes No
Employment Desired

Position When can you start?

Anticipated Salary Have you ever applied at CTi previously?

Can you work overtime? Yes No Preferred Location
Ability to Perform Job Function
Are you able to perform the essential functions of the job for which you are applying either with or without reasonable accommodations?

If no, describe the functions that cannot be performed.
Note: CTi complies with the Americans with Disabilities Act and consider reasonable accommodation measures that may be necessary for eligible applicants to perform essential functions.

Yes No

Emergency Contact

Name Relationship

Address
Street Address City State Zip

Phone Email
Skills
Many of our clients do not speak English? Do you speak, write or understand any other languages? Yes No
If yes, which language(s)?
   
Do you operate a personal computer? Yes No

If yes, what software?

What specific skills or training and/or capabilities do you have that especially prepare you for the position applied for?


   
Education

High School

Years Completed 1 2 3 4 Did you Graduate? Yes No

Diploma Attained?


College

Years Completed 1 2 3 4 Subjects Studied

Degrees Attained?


Trade or Business School

Years Completed 1 2 3 4 Subjects Studied

Degrees Attained?
Employment History
Please account for all employment within the last seven (7) years, beginning with your current employer.

Company Name

Employer Address
Street Address City State Zip

Telephone Supervisor's Name

Position Starting Salary/Ending Salary

Dates of employment Reason for leaving

May we contact your employer for reference? Yes No
 

Company Name

Employer Address
Street Address City State Zip

Telephone Supervisor's Name

Position Starting Salary/Ending Salary

Dates of employment Reason for leaving

May we contact your employer for reference? Yes No
 

Company Name

Employer Address
Street Address City State Zip

Telephone Supervisor's Name

Position Starting Salary/Ending Salary

Dates of employment Reason for leaving

May we contact your employer for reference? Yes No
 

Company Name

Employer Address
Street Address City State Zip

Telephone Supervisor's Name

Position Starting Salary/Ending Salary

Dates of employment Reason for leaving

May we contact your employer for reference? Yes No
Periods of Unemployment

From To Reason

From To Reason

From To Reason
Military Service
Have you obtained any special skills or abilities as a result of service in the military?

If yes, please describe.

Yes No
References : list at least three persons NOT related to you.


Name

Address
Street Address City State Zip

Phone Email


Name

Address
Street Address City State Zip

Phone Email


Name

Address
Street Address City State Zip

Phone Email
Applicants Statement: Please Read Carefully
1. I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
2.I hereby authorize CTi, to thoroughly investigate my references, work record, education and other matters related to my suitability for employment, and further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
3.I understand that CTi is committed to maintaining a drug and alcohol free work place. Accordingly, I may be subject to a pre-employment blood test, urinalysis or other drug/alcohol screening. I further understand that if employed, I may be subject to such a drug and alcohol screening if the company has reasonable suspicion to believe that I am under the influence of a drug or alcohol. My consent to submit to such a test is required as a condition of employment and my refusal to consent shall result in a refusal to hire or, if already employed, termination.
4.I understand and agree that the employment for which I am making application is, and is intended to be, at-will and such employment may be terminated at any time with or without cause, without prior notice, by either myself or CTi. There will be no agreement, express or implied, between CTi and me for any specific period of employment, nor for continuing or long term employment, unless made in writing, signed by the president of CTi.
5.Should a search of public records (including records documenting an arrest, indictment, conviction, civil judicial action, tax lien or outstanding judgment) be conducted by internal personnel employed by the Company, I am entitled to copies of any such public records obtained by the Company unless I mark the check box below. If I am not hired as a result of such information, I am entitled to a copy of any such records even though I have checked the box below.

6. I waive receipt of a copy of any public record described in the paragraph above.

7. I understand that this application will no longer be active and will receive no further consideration once the position for which I am applying has been filled.

By entering the word 'yes' into the box provided below you are stating that you have carefully read the above 6 (six) statements completed the entire form to the best of your ability.

Type the word 'yes' (without quotes) into the box provided.