New Employee Application – Clear Choice Safety System

Personal

Name*

First Middle Last

Home Phone

Cell Phone*

Email*

Are you at least 21 years of age or older?*

Yes
No

Are you legally authorized to work in the U.S.?*

Yes
No

Is any additional information relative to a name change (use of an assumed name or nickname) necessary to enable a check on your work record?

Have you ever applied to this organization before?*

Yes
No

If Yes, give date and position applied for

Have you ever been employed by this organization before?*

Yes
No

If yes, list dates of employment

Will you comply with the safety, work, and attendance policies of our organization?*

Yes
No

Employment Interests

Desired Location*

Date Available*

Type of Employment You Are Seeking:*

Part Time
Full Time

Availibility*

Open availibility
In School
Working another job
Working another job (but will quit for Clear Choice)
Have shift requirements (can't work nights)
Have shift requirements (can't work days)
Have shift requirements (can't work weekends)
Have shift requirements (can't work weekdays)

Do you have a reliable method of getting to work?*

Yes
No

How were you referred to our organization?*

Advertisement Source

Employee Name

Agency Name

Company Name

Education/U.S. Military Service

Do you have a high school diploma or equivalent?*

Yes
No

Do you have a university or college degree?*

Yes
No

Have you ever served in the U.S. Armed Services?

Yes
No

US Military Duties and special training

Rank held at discharge

References

List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row)

Name	Phone Number	Occupation	Years Known

Employment History

Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work.

Company Name (Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Did you have another job before this one?*

Yes
No

Company Name (Second Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list another previous job?

Yes
No

Company Name (Third Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

Would you like to list a 4th job?

Yes
No

Company Name (Fourth Most Recent)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Dates Employed

From	To

Job Title

Supervisors Name & Title

Type of Business

Business Website

Description of duties

Reason for Leaving?

May we contact this employer?

Yes
No

I agree to a Drug Screening at the company's expense.*

Yes
No

I agree to a Criminal Background Check at the company's expense.*

Yes
No

Signature

Print Name

Printing your First Name + Middle Initial

Resume Upload*

Please attach your resume here.

Cover Letter (optional)

Please upload your cover letter here. You may also copy and paste the contents of your cover letter in the space below.

Clear Choice Cannabis | Employment Application

Personal

Employment Interests

Education/U.S. Military Service

References

Employment History

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