Credit Collections Bureau (CCB) - Application for Employment - Sioux Falls
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Application for Employment
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Contact Information
Position(s) applied for
Name (Last, First, Middle)
*
Last, First, Middle
Address
City
State
Please Select
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Conneticut
Washington DC
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
ZIP Code
Telephone #
*
Cellular/Other #
E-mail Address
Referral Source (How did you hear about us)?
Applicant Information
If you are under 18 and it is required, can you furnish a work permit?
Yes
No
If no, please explain:
Have you ever been employed here before?
Yes
No
If yes, give dates and positions:
Is this application a request for reemployment following an extended military leave of absence from this company? (If yes, additional information may be requested)
Yes
No
Are you legally eligible for employment in this country?
Yes
No
Date available for work
What is your desired salary range?
Type of employment desired:
Full-Time
Part-Time
Temporary
Seasonal
Educational Co-Op
Are you able to perform the
Yes
No
Need more informatin about the job's "essential functions" to respond
Are you able to perform the "essential funtions" of the job for which you are applying (with or without reasonable accommodation)? This Question is not designed to elicit information about an applicant's disability. Please do not provide information about the existence of a disablility, particular accommodation, or whether accommodation is necessary. These issues may be addressed at a later stage to the extent permitted by law.
Driver's license number and issuing state required if driving may be required in the job for which you are applying
Have you ever pleaded
Yes
No
Answering "yes" to either part of the following question does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be taken into account. Have you ever pleaded "guilty" or "no contest" to, or been convicted of, a crime?
If yes, please provide date(s) and details
Social Security Number
Social Security Number We will use this information only for employment purposes and make reasonable efforts to safeguard your privace.
Employment History
Starting with your most recent employer, provide the following information.
Employer 1
Telephone #
Street address, City, State
Starting job title / final job title
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Yes
No
Later
E-mail
Why did you leave?
Summarize the type of work performed and job responsibilities.
Dates employed: (Month/Year) to (Month/Year)
Compensation (Starting)
Hourly
Salary
Compensation ($ per hr/yr)
Commission/Bonus/Other Compensation
Compensation (Final)
Hourly
Salary
Compensation ($ per hr/yr)
Commission/Bonus/Other Compensation
Employer 2
Telephone #
Street address, City, State
Starting job title / final job title
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Yes
No
Later
Email
Why did you leave?
Summarize the type of work performed and job responsibilities.
Dates employed: (Month/Year) to (Month/Year)
Compensation (Starting)
Hourly
Salary
Compensation ($ per hr/yr)
Compensation (Final)
Hourly
Salary
Compensation ($ per hr/yr)
Commission/Bonus/Other Compensation
Employer 3
Telephone #
Street address, City, State
Starting job title / final job title
Immediate supervisor and title (for most recent position held)
May we contact for reference?
Yes
No
Later
Email
Why did you leave?
Summarize the type of work performed and job responsibilities.
Dates employed: (Month/Year) to (Month/Year)
Compensation (Starting)
Hourly
Salary
Compensation ($ per hr/yr)
Compensation (Final)
Hourly
Salary
Compensation ($ per hr/yr)
Commission/Bonus/Other Compensation
Skills and Qualifications
Summarize any special training, skills, licenses and/or certificates that may assist you in performing the position for which you are applying:
Skills and Qualifications
Computer Skills (Check appropriate boxes. Include software titles and years of experience.)
Word Processing
Software title and years of experience
Spreadsheet
Software title and years of experience
Presentation
Software title and years of experience
E-mail
Software title and years of experience
Internet
Software title and years of experience
Other
Software title and years of experience
Educational Background
Starting with your most recent school attended, provide the following information.
School (include City & State)
Years Completed
Completed
Diploma
GED
Degree
Certification
Other
GPA / Class Rank
Major/Minor
School (include City & State)
Years Completed
Completed
Diploma
GED
Degree
Certification
Other
GPA / Class Rank
Major/Minor
School (include City & State)
Years Completed
Completed
Diploma
GED
Degree
Certification
Other
GPA / Class Rank
Major/Minor
References
List names and telephone numbers of three business/work references who are not related to you and are not previous supervisors. If not applicable, list three school or personal references who are not related to you.
Name
Title
Relationship to You
Telephone
E-mail
Number of years known
Name
Title
Relationship to You
Telephone
E-mail
Number of Years Known
Name
Title
Relationship to You
Telephone
E-mail
Number of Years Known
Applicant Statement
Signature of Applicant
*
Date
*
To be the best in our industry,
we have to give the best and produce the best result
- and we do.
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