Application Application For Employment Step 1 of 7 14% Personal InformationName(Required) First Last Social Security #(Required) Physical Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Mailing Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Message Phone(Required)Email(Required) Valid Driver's License?(Required) Yes No Driver's License #(Required) State(Required) Valid CDL?(Required) Yes No CDL #(Required) State(Required) Were you referred to us?(Required) Yes No By Who? Please list any medical issues that may limit your abilities Work HistoryCompany #1(Required) City(Required) Phone(Required) Supervisor(Required) Your Position(Required) Dates of Employment(Required) Company #2(Required) City(Required) Phone(Required) Supervisor(Required) Your Position(Required) Dates of Employment(Required) Company #3(Required) City(Required) Phone(Required) Supervisor(Required) Your Position(Required) Dates of Employment(Required) SkillsTo help us place you, please indicate what skills you have and how much experience you have in each skill. From 0 = None to 10 = ExpertJourneyman Carpentry(Required) Landscaping(Required) Janitorial(Required) Bartending(Required) Finish Carpentry(Required) Construction Labor(Required) Hotel Front Desk(Required) Office Administration(Required) Framing Carpentry(Required) Heavy Equipment Operator(Required) Hotel Housekeeping(Required) Typing (WPM)(Required) Roofing Construction(Required) Flooring Installation(Required) Breakfast Cook(Required) General Office(Required) Painting(Required) Certified Flagger(Required) Dinner Cook(Required) Bookkeeping(Required) Drywall Hanging(Required) Certified Welder(Required) Prep Cook(Required) Accounting(Required) Drywall Finishing(Required) Excavation(Required) Dishwashing(Required) Cash Handling(Required) Concrete Forms(Required) Carpet Cleaning(Required) Restaurant Server(Required) Retail Sales(Required) Concrete Finishing(Required) Mechanics(Required) Bar Server(Required) Retail Stock-Inventory(Required) Moving-Packing(Required) Management(Required) Supervising(Required) Data Entry(Required) *Computer Software Any other skills not listed above: Permission to Procure an Investigative Consumer Report Contractor's Clearing House, Inc. Applicant Name(Required) First Middle Last Please list other names used and dates of name change in the last ten (10) years: Name First Last Date of Change MM slash DD slash YYYY Name First Last Date of Change MM slash DD slash YYYY Name First Last Date of Change MM slash DD slash YYYY Name First Last Date of Change MM slash DD slash YYYY Date of Birth:(Required) MM slash DD slash YYYY Social Security Number:(Required) Driver's License Number:(Required) State Issued(Required) List All Residences In The Last 10 YearsState:(Required) City:(Required) County:(Required) Years:(Required) State:(Required) City:(Required) County:(Required) Years:(Required) State:(Required) City:(Required) County:(Required) Years:(Required) State:(Required) City:(Required) County:(Required) Years:(Required) To become employed by Coastal Temps we need a current I9 and W4. Please visit the links below to download and fill out a copy and attach them. Download W4 < a href="https://www.uscis.gov/i-9">Download I9I9 and W4 Uploads Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 123 MB. INVESTIGATIVE CONSUMER REPORT AUTHORIZATION In connection with my application, I understand that an investigative consumer report may be requested that may include information regarding my court records, both Civil and Criminal, my driving records, educational and professional credentials, and personal and professional references. This may come from public or private sources and may contain information regarding my character, experience, work habits, and reasons for termination from past employers. I understand that this document shall be kept on file and may be used at any time during my employment to procure an investigative report. I also understand that I may: (1.) Request in writing the nature of the information obtained and (2.) Request a written summary of my rights under the Fair Credit Reporting Act. I hereby agree that a photographic copy or a telephonic facsimile of this document shall be valid for all purposes present and future. I have read, understand, and agree with the above. I also understand the results of the Consumer report may be shared with co-employers.Digital Signature (Investigative Report)(Required) Date(Required) MM slash DD slash YYYY Drug Testing Consent As an employee of CONTRACTOR'S CLEARING HOUSE INC. DBA/COASTAL TEMPS., I understand that it is my responsibility to maintain a drug free workplace as a condition of employment. In the event of a Worker's Compensation claim, I hereby consent to submit to testing to determine the presence of alcohol or illegal substances in my body. I understand that refusal to submit to testing may result in denial of claim and disciplinary actions up to and including discharge. I also understand that all test results are confidential.Digital Signature (Drug Testing)(Required) Date(Required) MM slash DD slash YYYY Employee Handbook and Safety Manual As an employee of Contractors Clearing House, Inc. dba Coastal Temps and Coastal Employment Services, I understand that there are links to required reading available at www.coastaltemps.com I understand that it is my responsibility to download, print, or otherwise view these materials. I also agree to contact Contractors Clearing House, Inc. dba Coastal Temps and Coastal Employment Services in the event that I am unable to view these documents or if I have questions regarding the employee handbook and/or safety manual.Digital Signature (Employee Handbook)(Required) Date(Required) MM slash DD slash YYYY
