Customer Service Specialist/ Reception

Name *
Name
Date of Birth *
Date of Birth
Phone Number:
Phone Number:
Address
Address
Are you currently employed? *
Available to Start Employment: *
Available to Start Employment:
We require that you maintain a positive mental attitude with staff and customers whenever you are at work. Do you feel that you will be able to do this? *
If hired, are you willing to submit and pass a controlled substance test? *
Have you ever been convicted of a criminal offense (felony or misdemeanor)?
Employment - Please list two previous places of employment:
Supervisor's Name:
Supervisor's Name:
Employer's Phone Number:
Employer's Phone Number:
May we call for a reference?
Employer 2
Supervisor's Name:
Supervisor's Name:
Employer's Phone Number:
Employer's Phone Number:
May we call for a reference?
References - please list at least two references (other than family):
Name: *
Name:
Phone Number: *
Phone Number:
May we call for a reference? *
Name: *
Name:
Phone Number: *
Phone Number:
May we call for a reference? *