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CELINA considers applicants based on their knowledge, skills, & abilities for all positions and without regard to their race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected status. Information required on this application will not be used for any purpose prohibited by law.

PERSONAL INFORMATION

Name

Last Name

Phone Number

Email

Are you eligible for work in the US?

Address

Address Line 2

City

State

Zip Code

GENERAL INFORMATION

What is your availability?

Full Time Part Time

Overtime?

Yes No

Position Applying For

Are you at least 18 years old?

Yes No

Are you currently employed?

Yes No

May we contact your present employer?

Yes No

Have you ever been convicted of a felony?

Yes No

If yes, please explain

Have you ever been dismissed from a job for disciplinary reasons?

Yes No

Do you have any commitment or agreement with another employer that might affect your employment with CELINA?

Yes No

Minimum Salary Requirements

How did you learn about us?

If Referred, by Whom?

Have you served in the Armed Services ?

Yes No

Date Entered ?

Date Separated ?

Upload Cover Letter / Resumé

Education and Training

High School Attended

Select The Highest Grade Completed In Grade/High School

FR SOPH JR SR

Did you graduate or receive a GED from High School?

YES NO

College School Attended

Select The Highest Years Completed

FR SOPH JR SR

Did you graduate?

YES NO

Degree or Certificate

Course of Study or Major

Trade School Attended

Select The Highest Years Completed

FR SOPH JR SR

Did you graduate?

YES NO

Office Skills

Special Skills

Special Licenses

Additional Education and Training

Employment History

Company Name

Position

Start Date

Final Date

Name of Supervisor

Reason For Leaving

Description of Work and Responsibilities

Company Name

Position

Start Date

Final Date

Name of Supervisor

Reason For Leaving

Description of Work and Responsibilities

Company Name

Position

Start Date

Final Date

Name of Supervisor

Reason For Leaving

Description of Work and Responsibilities

REFERENCES

Name

Years Known

Phone

Relationship to Applicant

Name

Years Known

Phone

Relationship to Applicant

Name

Years Known

Phone

Relationship to Applicant

Name

Years Known

Phone

Relationship to Applicant

Name

Job Title

I wish to furnish this information

Yes No

419-586-3610
[email protected]
5373 State Route 29
Celina, Ohio 45822 USA

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