Last Name:
First Name:
Middle Initial:
Street Address:
City:
State:
--
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip:
Home Phone:
Relative's Phone:
Business Phone:
Cell Phone:
Email Address:
SSN:
How did you hear of The CPI Group?
College or University FEAP Flyer Friend Impact Internet Job Fair Newspaper Radio Ad The Mall Walk-in WIN Job Center Yellowbook Yellowpages Select Reference Source
Position Desired:
Part Time
Full Time
Either
Salary or Wage Desired:
Least wage you will accept:
$10.00 $11.00 $12.00 $6.00 $7.00 $8.00 $9.00 MIn. N/A
Select Driver's License Class:
Class A Class B Class C Class D No Regular
Have you ever been
convicted of a crime, felony or misdemeanor?
Yes No
If yes,
Type of Offense
When did this happen?
Where (county and state)
Was this a felony?
Yes
Did you serve time in jail or prison?
Yes
If so when?
Are you currently on Parole?
Yes
Name of your Parole Officer?
Reliable transportation to any CPI job site
is your responsibility. You must have a
personal transportation plan in place to
arrive and depart the CPI work site, particularly
for shifts when public transportation may
not be operating.
Do you have reliable
transportation?
Yes No
EMPLOYMENT HISTORY
*Give last position first
SKILL DETAILS
It is the policy
of The CPI Group, Inc. to provide equal
employment opportunity to all persons regardless
of age,
color, national origin, citizenship status,
physical or mental disability, race, religion,
creed, gender, sex, sexual
orientation, gender identity and/or expression,
marital status, status with regard to public
assistance, status as a
disabled veteran and/or Veteran of the Vietnam
Era or any other characteristic protected
by federal, state or local
law.