620.947.2664 INFO@CSIBOTTLES.COM

Employment Application

Applicant Information

Last Name (required)

First Name (required)

Middle Initial


Street Address

Apartment/Unit #


City

State

Zip


Phone Number

Email Address (required)


Date Available

Shift

Desired Salary


Position applied for (Check all that apply)


Are you a citizen of the United States?

If NO, are you authorized to work in the U.S.?


Have you ever applied to this company?

If so, when?


Do you have any relatives that work here?

If so, who?


What form of transportation do you have?


Education

High School

Address

Did you graduate?

Degree



College

Address

Did you graduate?

Degree



Other

Address

Did you graduate?

Degree


References

Full Name

Relationship


Company

Phone Number

Address


Full Name

Relationship


Company

Phone Number

Address


Full Name

Relationship


Company

Phone Number

Address


Previous Employment

Please list your most recent employer first.

Company

Phone


Address

Supervisor


Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact this employer for a reference?


Company

Phone


Address

Supervisor


Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact this employer for a reference?


Company

Phone


Address

Supervisor


Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact this employer for a reference?


Company

Phone


Address

Supervisor


Job Title

Starting Salary

Ending Salary

Responsibilities

From

To

Reason for Leaving

May we contact this employer for a reference?


Criminal Record

Have you ever been convicted of any of the offenses in the drop-down list below?

Click for list of offenses

  1. Abandonment of a Child
  2. Abuse
  3. Abuse of a Child
  4. Aggravated Abandonment of a Child
  5. Aggravated Arson
  6. Aggravated Battery
  7. Aggravated Burglary
  8. Aggravated Incest
  9. Aggravated Robbery
  10. Aggravated Sodomy
  11. Aiding Escape
  12. Altering a Legislative Document
  13. Arson
  14. Assault
  15. Assisting Suicide
  16. Battery
  17. Bigamy
  18. Blackmail
  19. Bribery
  20. Burglary
  21. Contributing to a Child’s Misconduct or Deprivation
  22. Criminal Damage to Property
  23. Criminal Nonsupport
  24. Criminal Restraint
  25. Criminal Threat
  26. Electronic Solicitation
  27. Endangering of a Child
  28. Exposing Another to a Life Threatening Communicable Disease
  29. Forgery
  30. Furnishing Alcoholic Liquor/Beverage or Cereal Malt Beverage to a Minor
  31. Harassment
  32. Hazing
  33. Illegal Use of Weapons of Mass Destruction or Furtherance of Terrorism
  34. Incest
  35. Indecent Liberties With a Child/Ward
  36. Indecent Solicitation of a Child
  37. Injury to a Pregnant Woman
  38. Interference with Parental Custody
  39. Interference with the Conduct of Public Business in a Public Building
  40. Interference with the Custody of a Committed Person
  41. Intimidation of a Witness or Victim
  42. Involuntary Manslaughter
  43. Kidnapping
  44. Lewd and Lascivious Behavior
  45. Making False Writing
  46. Mistreatment of a Confined Person
  47. Mistreatment of a Dependent Adult
  48. Murder
  49. Obstructing Legal Process or Official Duty
  50. Official Misconduct
  51. Patronizing a Prostitute
  52. Perjury
  53. Permitting Dangerous Animal to be at Large
  54. Poisoning
  55. Possession, Possession with the Intent to Sell
  56. Promoting Obscenity
  57. Promoting Prostitution
  58. Prostitution
  59. Rape
  60. Robbery
  61. Sale, Manufacture or Production of any Drug Listed in the Uniform Controlled Substances Act, KSA 65-4101 et. Seq.
  62. Sedition
  63. Sexual Battery
  64. Sexual Exploitation of a Child
  65. Sodomy
  66. Stalking
  67. Terrorism
  68. Theft
  69. Threat, Criminal or Terroristic
  70. Trafficking
  71. Treason
  72. Unlawful Administration of a Substance
  73. Unlawful Disclosure of Tax Information
  74. Unlawful Interference
  75. Unlawful Sexual Relations
  76. Vehicular Homicide
  77. Voluntary Manslaughter
  78. Any other crimes including attempts, conspiracies, and solicitation to commit any of the crimes listed

If YES, give details, including offense, date and location.

Offense #

Date Convicted

Details (including location where conviction occurred)


Offense #

Date Convicted

Details (including location where conviction occurred)


Offense #

Date Convicted

Details (including location where conviction occurred)

Notice: Prior convictions will not necessarily bar you from employment with this company.


Military Service

Branch

From

To


Rank at Discharge

Type of Discharge

If other than Honorable, explain:


Disclaimer and Signature

Please read carefully!

In exchange for the consideration of my job application by Container Services, Inc. (hereinafter referred to as “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Container Services, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /Owner of the Company. Both the undersigned and Container Services, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of my employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be provisional for a period of ninety (90) days, and further that at any time during the provisional period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Signature: Sign by clicking and dragging your cursor in the box below.

Alternatively, you may type your full name in here as your signature:

Date


This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.