Employment Application

    Personal Information

    First Name: *

    Middle Initial:

    Last Name: *

    Home Address: *

    City: *

    State: *

    Zip: *

    Date of Birth: *

    Social Security Number:

    Home Phone:

    Cell Phone: *

    Email: *

    Service Record

    Branch of Service:

    Enlistment Date:

    Discharge Date:

    Rank:

    Desired Employment

    Position:

    Date you can start: *

    Desire pay range (hourly or salary):

    Are you employed now? *

    Have you ever applied to Champion Ice before? *

    If so when?

    Have you ever worked for Champion Ice before? *

    If so when?

    Reason for leaving:

    How did you learn about Champion Ice?

    Education

    High School Name and City/State: *

    Number of years attended: *

    Did you graduate? *

    College Name and City/State:

    Number of years attended:

    Did you graduate?

    Degrees:

    Trade, Business School or Certificates:

    Special Training:

    Special Skills:

    Driver Details

    Did you have a Driver's License? *

    Driver's License Number:

    State:

    What kind of Driver's License do you have?

    Any Endorsements?

    Code:

    Date:

    Code:

    Date:

    Code:

    Date:

    If applying for a Deliver Driver/Router Driver Position, please answer the following questions:

    Date of last accident:

    Nature of accident (e.g., Head on, Rear end):

    Traffic convictions in the past 3 years (other than parking):

    Former Employers

    List below last three Employers, starting with the most recent one first:

    Name of Present or Last Employer:

    Address:

    City:

    State:

    Zip:

    Phone:

    Starting Date:

    Leaving Date:

    Job Title:

    Pay Rate:

    Supervisors Name and Title:

    Duties Performed:

    Reason for Leaving:

    May we contact them?

    Name of Previous Employer:

    Address:

    City:

    State:

    Zip:

    Phone:

    Starting Date:

    Leaving Date:

    Job Title:

    Pay Rate:

    Supervisors Name and Title:

    Duties Performed:

    Reason for Leaving:

    May we contact them?

    Name of Previous Employer:

    Address:

    City:

    State:

    Zip:

    Phone:

    Starting Date:

    Leaving Date:

    Job Title:

    Pay Rate:

    Supervisors Name and Title:

    Duties Performed:

    Reason for Leaving:

    May we contact them?

    References

    Below give the names of three people you are not related to, whom you have known at least one year:

    Name: *

    Address: *

    Phone: *

    Years Acquainted: *

    Name: *

    Address: *

    Phone: *

    Years Acquainted: *

    Name: *

    Address: *

    Phone: *

    Years Acquainted: *

    Have you been convicted of a felony within the last 5 years? *

    Acknowledgement and Authorization

    *
    *
    *