Employment Application

Personal Information

Name(Required)

First Middle Initial Last

Address 1(Required)

Address 2

City(Required)

State(Required)

Zip Code(Required)

Phone(Required)

Alternate Phone

Email(Required)

Availability

Position Applying For(Required)

Are you employed now?

Yes

If so, may we inquire of your present employer?

Yes

Current Employer

Date Availalble to Start Work

Salary Desired

Type of position desired: (Select all that apply)(Required)

Full-Time

Part-Time

Seasonal

Shift Desired(Required)

Any

Days

Evenings

Weekends

Have you ever been employed by us?

Yes

If yes, when?

Do you have relatives that work for CDH, Inc?

Yes

Relative's Name

Relationship to Relative

Relative's position at CM3

Are you authorized to work in the U.S.?(Required)

Yes

Have you been convicted of a felony or misdemeanor crime in the last 7 years?(Required)

Yes

If yes, please give details:(Required)

List any certifications / trade licenses:

Do you have a valid Kansas driver's license?

Yes

Are you a licensed Kansas CDL driver?

Yes

Kansas CDL type?

Class A

Class B

Endorsments

How did you hear about us?

School

Current / Former Employee Referral

Internet

Temp Service

Walk-In

Other

Education

High School

School Name

Address

City

State

Zip Code

Graduated?

Yes

Number of Years Completed

College

School Name

Address

City

State

Zip Code

Graduated?

Yes

Number of Years Completed

Major (if applicable)

Trade/Technical/Other School

School Name

Address

City

State

Zip Code

Graduated?

Yes

Number of Years Completed

Subject of study?

Other Training

U.S. Military Service

Rank

List any skills or additional training you think might be helpful to your application.

Work History

Start with your present or most recent job, include military service assignments and volunteer activities.

Employer One

Name of Employer

Job Title

Date Started

Date Ended

Address

City

State

Zip Code

Phone

Supervisor Name

Type of Job

Full Time

Part Time

Seasonal

Beginning Salary

Ending Salary

Summary of Duties

Reason for Leaving

Employer Two

Name of Employer

Job Title

Date Started

Date Ended

Address

City

State

Zip Code

Phone

Supervisor Name

Type of Job

Full Time

Part Time

Seasonal

Beginning Salary

Ending Salary

Summary of Duties

Reason for Leaving

Employer Three

Name of Employer

Job Title

Date Started

Date Ended

Address

City

State

Zip Code

Phone

Supervisor Name

Type of Job

Full Time

Part Time

Seasonal

Beginning Salary

Ending Salary

Summary of Duties

Reason for Leaving

Employer Four

Name of Employer

Job Title

Date Started

Date Ended

Address

City

State

Zip Code

Phone

Supervisor Name

Type of Job

Full Time

Part Time

Seasonal

Beginning Salary

Ending Salary

Summary of Duties

Reason for Leaving

Upload Resume

File

Accepted file types: pdf, jpg, jpeg, Max. file size: 5 MB.

Acknowledgement and Agreement

Please read before confirming.

CDH, Inc. is an equal opportunity employer. All qualified applicants will receive consideration for employment without illegal discrimination because of race, color, religion or creed, sex/gender, nation origin or ancestry, citizenship, protected veteran or disabled status, age, disability/handicap, genetic information, marital status, or any other characteristics protected by law.

I understand and acknowledge that any employment relationship with CDH, Inc. is “at will” which means that I may resign at any time and that the Company may terminate my employment at any time, with or without cause, and without prior notice. I understand that no representative of the Company has the authority to make any assurances to the contrary.

I certify that all statements on this application are true and complete and that I have not withheld any information which would, if disclosed, affect this application unfavorably. Omitted information or false information provided on this application form or during the interview will be sufficient cause for cancellation of this application and/or termination from employment. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

BY CHECKING THE BOX BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS.

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