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Citywide Courier - Employment Application Form
Programs, services and employment are equally available to everyone. Please inform the Human Resources Department if you require reasonable accomodation for application of Interview.
Date of Interview
(Month/Day/Year):
Applicant Data
Position Applied For:
How were you referred to us?
Full Name:
Address:
City:
State:
Zip:
Phone:
Mobile/Pager/Other:
Email:
Driver’s License #:
State:
Date of Birth:
Date Available to Start :
Social Security Number:
Salary Requirements:
If you are under 18 years of age, can you provide a Permit?
If No, Please Explain:
Yes
No
Have you ever worked for this company?
If yes, when:
Yes
No
Are you legally allowed to work in the United States ?
Yes
No
Type of employment desired :
Full-Time
Part-Time
Temporary
Seasonal
What hours are you available?
Have you ever pleaded guilty, no contest or been convicted of a crime?
If Yes, Please Explain:
Yes
No
Answering yes to these questions does not constitute an automatic rejection for employment. Date of offense, seriousness and nature of the violation, rehabiliation and postion applied for will be considered.
Summarize Your Special Skills or Qualifications
Vehicle Description
Year:
Make:
Model:
Signature
Date
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