Employment Application

Education

List below any job related education including trade/technical training.

High School Location Dates Attended Number of years Graduate? Yes No College Location Dates Attended Number of years Graduate? Yes No Vocational / Technical Location Dates Attended Number of years Graduate? Yes No

Employment History

List below all present and past employment starting with your most recent employer. (last 10 years is sufficient)

Name and Address of Company Employment Dates Starting Salary Final Salary Reason for Leaving Name and Address of Company Employment Dates Starting Salary Final Salary Reason for Leaving Name and Address of Company Employment Dates Starting Salary Final Salary Reason for Leaving

Business or Personal References

List persons who have first-hand knowledge of your work performance within the last three years.

Name and Address Phone Number Occupation Relationship Name and Address Phone Number Occupation Relationship Name and Address Phone Number Occupation Relationship

Supplemental Information

Do you have a late model RV, or Travel Trailer? If so, please describe. If not, how are you planning to maintain a residence? Are you limited in the hours you can work? If yes, please explain. What interests you in this type of work? A significant part of your job will include cleaning toilets? Do you any objections to performing that type of work? What are your interests in working with the public? Please list any additional information which will help us assess your qualifications.

Certification

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.

I hereby authorize CLM Services Corporation to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize my former employers 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.

I understand that nothing contained in the application or conveyed during any interview which may be granted is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative.

Confirm with your initials: *

Drivers License

In the position you are applying for required that you drive a motor vehicle, please list your drivers license number and state.

Drivers license # State issued

Employment Application

Employment Application Received

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