CEDARS : Join Our Team : Employment : Employment Online Application

ALL FIELDS ARE REQUIRED TO BE CONSIDERED FOR EMPLOYMENT!!! For your application to be considered, you must indicate a specific position in the "Position Desired" field.

First Name:

Last Name:

Middle Initial:

Address:

City, State, ZIP:

Home Phone:

Work Phone:

Email Address:

Position Desired:

Position Type:

Shift:

	Days
	Evenings
	Overnights
	Weekends

Available Start Date:

Are you at least 19 years of age:

	Yes
	No

Are you a U.S. citizen, or otherwise authorized to lawfully work in this country? :

	Yes
	No

Have you filled out an application here before?:

	Yes
	No

If yes please give date:

Have you ever been employed here before?:

	Yes
	No

If yes, please give date:

EDUCATION

High School:

Years Completed:

Year of Degree/Diploma:

University/College:

Years Completed:

Major:

Year of Degree/Diploma:

Graduate School:

Years Completed:

Major:

Year of Degree/Diploma:

Related Education/Achievements (licenses, trainings, certifications, honors):

EMPLOYMENT HISTORY (Beginning with most recent)

Employer #1:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

Ending Pay:

From: Mo/Yr:

To: Mo/Yr:

Reason for Leaving:

Specific Duties:

Employer #2:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

Ending Pay:

From: Mo/Yr:

To: Mo/Yr:

Reason for Leaving:

Specific Duties:

Employer #3:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

Ending Pay:

From: Mo/Yr:

To: Mo/Yr:

Reason for Leaving:

Specific Duties:

Employer #4:

Street Address:

Position Held:

Supervisor:

Phone:

Hours Per Week:

Ending Pay:

From: Mo/Yr:

To: Mo/Yr:

Reason for Leaving:

Specific Duties:

REFERENCES

(Please provide complete addresses for all references listed)

Reference #1:

Phone:

Relationship:

Address:

City, State, ZIP:

Reference #2:

Phone:

Relationship:

Address:

City, State, ZIP:

References #3:

Phone:

Relationship:

Address:

City, State, ZIP:

BACKGROUND INFORMATION

(Please answer the questions below as completely as possible.)

Have you ever been convicted of a violation of law other than a minor traffic violation?:

	Yes
	No

If yes, please describe:

EMPLOYEE REFERRAL

Were you referred to CEDARS by a current CEDARS employee?:

	Yes
	No

If so, please include their name:

GENERAL QUESTIONS

How did you hear about our employment opportunities:

What interests you in employment with us:

DEMOGRAPHIC INFORMATION

We request your cooperation in completing the following voluntary applicant demographic information. This information will not be used in making any decision affecting employment or any personnel action following employment. It will be used to complete records required of CEDARS by governmental authorities.

Today's Date: Mo/Day/Yr:

Name: Last/First/M.I. :

Gender:

	Male
	Female

Date of Birth: Mo/Day/Yr:

Social Security Number:

Recruitment Source:

Position Appling for:

Ethnic Background:

	WHITE (not of Hispanic origin): Persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.
	BLACK (not of Hispanic origin): All persons having origins in any of the black racial groups of Africa.
	HISPANIC: All persons of Mexican, Puerto Rican, Cuban, Central South American, or other Spanish culture or origin, regardless of race.
	AMERICAN INDIAN OR ALASKAN NATIVE: All persons having origins in any of the people of North America, and who maintain cultural identification through tribal affiliation or community recognition.
	ASIAN OR PACIFIC ISLANDERS: All persons having origins in any of the original peoples of the Far East, Southeast Asia, the Indian Subcontinent or Pacific Islands. For example, China, Japan, Korea, the Philippines Islands, and Samoa.

Do you have any physcial disabilities that may affect or limit your work:

	Yes
	No

If yes, please describe:

Citizenship or Immigration Status:

	U.S. Citizen
	Immigrant alien (admitted to the U.S. for lawful permanent residence) with Alien Registration Receipt form I-551
	Non-immigrant alien (admitted to the U.S. temporarilyfor specific purpose).

CERTIFICATION OF APPLICANT

By submitting this form, you certify that the information contained in this application is true to the best of your knowledge and belief. You understand that any material omission of facts or misrepresentation may result in your discharge, if hired, regardless of when discovered. Unless otherwise expressly stated in a written appointment to a position or in a written contract of employment duly approved and executed by CEDARS, employees are considered at will, and either CEDARS or the employee may terminate the employment relationship upon giving the proper advance notice. You grant permission to CEDARS to investigate your employment record, educational record, criminal record and other records to verify the information you have provided on this application and release CEDARS from any liability resulting from such investigation.

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