Customer Service Application Name* First Last Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*Email* Are you a US citizen?* Yes No Any felony convictions?* Yes No Are you 21 or older?* Yes No Upload resume if you have one (not required).Accepted file types: pdf, txt, rtf, doc, docx, Max. file size: 2 MB.List any foreign languages spoken or classes taken:*Tell us why you would be a good fit for this position?*What are some of your interests or what do you like to do in your free time?*RECENT WORK HISTORYCurrent or Previous EmployerDates EmployedPostitionPay RateReason for leaving?Supervisor's NameMay we contact them? Yes No REFERENCES - Please list two:Reference #1 - Name*Reference #1 - Relationship*Reference #1 - Phone*Reference #2 - Name*Reference #2 - Relationship*Reference #2 - Phone*Acknowledgement and Authorization* I certify that all answsers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. Name of person completing application*Date Submitted* MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ
