EMPLOYMENT

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Personal Data
First Name*
Last Name*
Middle Name
Any Previous Name
Street Address*
City*
State*
Zip Code*
Social Security Number*
Phone*
Employment Information
Have you ever filed an application here before?*
Application Date*
Date Format: MM slash DD slash YYYY
Were you referred by a current employee?*
Please specify employee name, clock number and type of relation (relative, friend, former co-worker, etc)*
Have you ever worked for this company?*
Date of Employment*
Date Format: MM slash DD slash YYYY
When can you start to work if employed?*
Date Format: MM slash DD slash YYYY
Are you legally eligible to work in the United States? (Proof of eligibility will be required upon offer of employment)*
Are you at least 18 years of age? (If not, authorization may be required)*
Are you currently employed?*
How long since your last employment?*
What position(s) are you seeking?*
What skills/qualifications do you have that can apply if you are employed here?*
Are you able to meet the attendance requirements of the position?**
Are you able to work any or all days and any or all shifts?**
Please Explain shift requirements.*
Education
Elementary School
Elementary School
Course of Study/Major
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
Degree/Diploma
High School
High School
Course of Study/Major
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
High School Degree/Diploma
College (Undergrad)
College (Undergrad)
Course of Study/Major
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
Business School Degree/Diploma
Grad School
Grad School
Course of Study/Major
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
College Degree/Diploma
Other (Trade, Vocational, Business, Correspondence)
Other (Trade, Vocational, Business, Correspondence)
Course of Study/Major
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
College Degree/Diploma
Past Employment
(Begin with most current employer. List all employers in last seven years. Do not exclude any employment. Include any applicable temporary employment.)
Current or Most Recent Employer:
Company Name
Supervisor
Nature of Business
Job Title
Responsibilities
Reason for Leaving
Address
Phone
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
May we contact?
Employer #2:
Company Name
Supervisor
Nature of Business
Job Title
Responsibilities
Reason for Leaving
Address
Phone
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
May we contact?
Employer #3:
Company Name
Supervisor
Nature of Business
Job Title
Responsibilities
Reason for Leaving
Address
Phone
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
May we contact?
Military Service
Dates of Military Service
From:
Date Format: MM slash DD slash YYYY
To:
Date Format: MM slash DD slash YYYY
Branch of Service
Type of Discharge
Reserve Status
Reserve Date
Date Format: MM slash DD slash YYYY
Rank or Title Upon Discharge
Please provide any additional information you feel will help us in considering your application for employment.
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PLEASE READ CAREFULLY BEFORE SUBMITTING

I hereby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to the Company and/or any of its representatives, agents or vendors.

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I further agree that any false statements or incomplete answers will disqualify me for employment or, if hired, cause my subsequent dismissal upon learning of such false or incomplete answers, regardless of the timing or circumstances of discovery.

I understand that CHS Acquisition Corp. is an at-will employer, subject to the terms of any applicable collective bargaining agreement, and I understand that no person may make any oral offers of employment inconsistent with at-will employment. I understand that acceptance does not bind either party to a specific period of employment.

I agree to abide by all Company rules and regulations. I understand that due to the nature of the Company’s business, attendance and punctuality are considered essential requirements of every job at the Company and that poor attendance or tardiness will result in disciplinary action.

I understand that my Application will remain active for a period of no more than 30 days from the date of application. After that period of time I will no longer be considered for employment.

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

CHS ACQUISITION CORP. IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.

211 E. Main Street Chicago Heights, IL 60411

Phone Number: 1 (708) 756-5648 | Toll Free: 1 (800) 424-4487 | Fax Number: 1 (708) 756-5628

Phone Number: 1 (708) 756-5648
Toll Free: 1 (800) 424-4487
Fax Number: 1 (708) 756-5628

211 E. Main Street Chicago Heights, IL 60411

EMPLOYMENT

Personal Data

Employment Information

Education

Elementary School

High School

College (Undergrad)

Grad School

Other (Trade, Vocational, Business, Correspondence)

Past Employment

Current or Most Recent Employer:

Employer #2:

Employer #3:

Military Service

Dates of Military Service

PLEASE READ CAREFULLY BEFORE SUBMITTING