Application for Employment

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of non-job- related medical condition or disability, or any other legally protected status.

How Did You Learn About Us? *

  • Advertisement
  • Friend
  • Walk-In
  • Employment Agency
  • Relative
  • Other

  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo
On what date would you be available for work?
Are you available to work:
  • Full Time
  • Part Time
  • Shift Work
  • Temporary
Shift preferred:
  • Day
  • Night
  • YesNo
  • YesNo
  • YesNo
  • YesNo
  • YesNo



Elementary School High School Undergraduate College / University Graduate / Professional
School Name and Location
Years Completed
Diploma / Degree /
Mo/Yr Completed
Describe Course of Study

Describe any specialized training,apprenticeship, skills and extra-curricular activities
Describe any honors you have received
State any additional information you feel may be helpful to us in considering your application
Indicate any foreign languages you can speak, read and / or write
List professional, trade, business or civic activities and offices held.

You may exclude memberships which would reveal sex, race, religion, national origin, age,ancestry, or disability or other protected status.

For positions requiring office equipment skills-

Indicate office machines you operate and skill level.

  • YesNo

Employment Experience

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, sex, national origin, disability or other protected status.


  • YesNo


  • YesNo


  • YesNo

Special Skills and Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.

Thank you for completing this application form and for you interest in employment with us. We would like to assure you that your opportunity for employment with this company will be based on your merit and on no other consideration.

Applicant Data Record
Applicants are considered for all positions, and employees are treated during employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap.
As an employer/government contractor, we comply with government regulations and affirmative action responsibilities.
Solely to help us comply with government record keeping, reporting and other legal requirements, please fill out the Applicant Data Record. We appreciate your cooperation. Refusal to provide this information will not subject you to adverse treatment.
This data is for periodic government reporting and will be kept in a Confidential File separate from the Application for Employment.

  • Advertisement
  • Friend
  • Walk-In
  • Employment Agency
  • Relative
  • Other

Applicant’s Statement

I certify that answers 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.

This application for employment shall be considered active for a period of time not toexceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquireas to whether or not applications are being accepted at that time.

I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

I agree that the company reserves the right to require me to submit to a drug / alcohol test prior to employment and at any time during my employment, to the extent permitted by law. I also understand that if I should receive a conditional offer of employment I may be required to submit to a medical examination or medical inquiries to determine my ability to perform the essential functions of the job for which I have applied.


Date Called
By whom
Eligible YesNo
Arrange Interview YesNo



Disclosure/Release of Liability

I    ,Date of Birth    (month and day only if used for employment) Social Security Number   , do hereby authorize Carolina Constructions & Industrial Services (CCI Services) of Fayetteville, NC to conduct a background investigation into the following areas of my personal and employment history, current and previous employment, education, credit, driving records, criminal and civil records, professional licensing, and general character including honesty.

My driver’s license number is    and was issued on   
Sex: MaleFemale


Current Address

Length at current address

(if less than 7 years please provide previous address)
Previous address (1)

Previous address (2)

Length at previous address (1)   , Length at previous address(2)   


I hereby authorize any person, agent, corporation, company, agency, or institution to release any information, document, or assessments they posses regarding me or my performance as an employee, student, associate, or acquaintance. I release and permanently hold harmless, CCI Services their agents and assigns, and the REQUESTER and their agents and assigns, from any and all demands and or liabilities that may originate from these investigations, or any demand or liability which may result from any physical examination, drug testing procedure, x-rays, or other medical screening procedures conducted by them or their agents and any person, corporation, company institution, or their agents who may act upon the authority of this release. I hereby authorize that a photocopy or electronic facsimile of this document shall serve as an original. If a notarized copy of this document is required for any background check, the notarized copy will be provided.


  • I certify that the answers given in this document are true and complete to the best of my knowledge.