CAASTLG, Ine.
2709 Woodson Road, St. Louis, MO. 63114
(314) 863-0015 VAX (314) 863-1252
Application for Employment
‘CAASTLC, ne. isan equal opportunity employer and docs not unlawful discriminate in employment. No
‘quetion on ts apliion i asd fo the purpose of imtingo excluding ny applicant rom canisetion a
{Employment 0 a bass probed by local sate, or fdeal lw. Equal aces to employment sevice, and
[pograms is lahe toa penons Thos applica requiring reasonable accommodation the eppicon adr
{nerview proses should no a represent ofthe oraniaton.
PERSONAL INFORMATION
Applicant name: Date
Address:
‘Telephone #: Socil Security #
EMPLOYMENT DESIRED
Position(s) applied for or type of work desired:
‘Type of employment desired: __fullime —_parttime _termporary
Date you will be available to work:
‘Are you able to meet the attendance requirement? —_Ye __No
‘Do you have objection to working overtime ifnecessary? _Yet _No.
Can you travel if required by this position? Ye __No
mais tava tenia STAM vy
‘Ace you now employed? —Ye __No
feurrently employed, may we inquire of your
present employer? cvs
Can you submit proof of legal employment
authorization and identity? Yes __NoIfyou are under 18, can you furnish a work permit,
‘fit is required? Ye __No
Have you every been convicted of «crime? Yes __No
yes, please explain (@ conviction will not automatically bar employment):
BrP eeeece eee eee eet eee terrae
Oe
Driver's license mamber (if driving isan essential job duty):
Tssuing State ‘Auto Insurance Carrier —
‘Do you lave the capacity to perform the duties for
which you have applied? Yes __Ne
IFNo, please explain:
eee eS e—Seos
oO
OOO
How were you refered to us?
‘Do you currently have friends or relatives employed by
CAASTLC, Ine. or current members of the Board of Directors? _Yes _No
EMPLOYMENT HISTORY
‘lene provide all employment information for your past four employes starting with the most cea,
(Current Employer: Position held:
ipddese cect
hone #:
Employer: Position held
Address: Phone #:
Immediate supervisor and tite: os
Job duties:
‘Reason for faving: SPE EE eee eo eccoEmployer: Postion hel
Dates employed: from. r Salary
Tob duties:
Employer: Position held:
‘Address Phone
‘Dates employed: from Salary:
OTHER SKILLS AND QUALIFICATIONS
Summarize any job-related training, skills, licenses, certificates, and/or other qualificatens:
EDUCATIONAL HISTORY
Sehosl Name | Toaaioa Yer ‘Coase of] Degies
Completed __| sty Baral
High School
College
"Technical
TrainingREFERENCES
List tree (3) references (do not include relatives or employers)
ane “Rares ‘Phone Namber
EMERGENCY RECORD
In case of emergency natty
‘Name: Relaion:
Address: Phone Na
"ery tho te atl gly cont cs nd vy anny fnfomtion nin tit
‘pplication froma peviou employers, edvatona nstions, and ereaes. Taso hereby release fom Llity
‘to pte caployer end serous for eng. aolng at sng ch norman to make
‘employment decisions eal oer pron or organization for proving such information
| understand tht any misepreenatono matrlomission made by a ths application willbe suficieat case
{fo cenocllton of thi eppiraton or inmediate termination of employe Tam employed, whencveritmay be
‘understand that tie th policy ofthis organization not to ref ohio otherwise iscriminat agains quali
{nv wih silty bocaze of that peron eo! fra ezonble accommodation as required bythe ADA.
{also understand tat if Tam employed, wil be rege to pvidesistctor proof of identity and legal work
suthorzation wih tres G) day of beng hired. Fall tsb uch proof within the required time shal est
In immodite eration of employment
{represent and wana ht have read and flly understand he foregoing and tha sek employment under these
conditions,
Applicant's Signature Date:
1.3004 pen spin