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Equal Access to programs, services, and employment is available to all persons. Those applicants requiring reasonable accomodation to the application and/or interview process should notify the representative of the Human Resource Department.

Mobile/Beeper/Other Phone #:

Position(s) applied for: *

Location(s) applied for: *

St. Charles
Kansas City
Denison

Availability: *

Full Time
Part Time

Legally eligible for employment in the US?: *

Previously applied with Client Services, Inc?: *

Previously employed with Client Services, Inc?: *

Have you ever: *

If you answered yes to question 1, 2, and/or 3 above, please provide date(s) and details in the below space.

(Note to Applicant: answering "Yes" to questions 1, 2, and/or 3 above does not automatically disqualify an applicant for consideration of employment with Client Services, Inc. Please supply as much information as possible to assist in the applicant review process).

Employment History

Provide the following information of your past three (3) employers or assignments, starting with the most recent.

Skills and Qualifications *

Summarize any training skills, licenses and/or certifications that may qualify you as being able to perform job-related functions in the position for which you are applying.

Educational Background

References *

Application Statement *

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for termination of my employment.

I authorize investigation of all statements contained herein and authorize the references and employers listed above to give the Company any and all information concerning my pervious employment and any pertinent information they may have, personal or otherwise, and I release the Company from all liability for any damage that may result from utilization of such information.

I also understand that my employment is “employment at will,” which means either I or the Company may terminate my employment at any time, with or without cause, and with or without notice. I agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by the President or CEO of Client Services, Inc.

This waiver does not permit the release or use of disability – related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

From	To	Employer	Telephone #
Starting Title	Final Title	Address:
Supervisor and Title		Summarize the nature of work performed and job responsibilities	Salary
May we contact for reference? Yes No Later		Reason for leaving

From	To	Employer	Telephone #
Starting Title	Final Title	Address:
Supervisor and Title		Summarize the nature of work performed and job responsibilities	Salary
May we contact for reference? Yes No Later		Reason for leaving

From	To	Employer	Telephone #
Starting Title	Final Title	Address:
Supervisor and Title		Summarize the nature of work performed and job responsibilities	Salary
May we contact for reference? Yes No Later		Reason for leaving

	Name and Location	Years Finished	Did you Graduate?		Course of Study
High School			Yes No
College			Major	Degree
Other			Yes No

Application for Employment

Employment History

Skills and Qualifications *

Educational Background

References *

Application Statement *