APPLICATION FOR EMPLOYMENT
3868 Congress Parkway
Richfield, OH 44286
http://www.ccgenergysolutions.com

As an EQUAL EMPLOYMENT OPPORTUNITY, CCG Energy Solutions, Inc. does not discriminate against applicants or employees because of their age, race, color, religion, national origin, sex, or any other basis prohibited by law. Furthermore, CCG Energy Solutions, Inc., will not discriminate against any applicant or employee because her or she is mentally or physically handicapped, a disabled veteran, a veteran of the Vietnam era, or has a non-job related medical condition, provided he or she is qualified and meets the requirements established by CCG Energy Solutions, Inc. for the job.


Name
Last First Middle
Present Address
Street City Zip
Phone Numbers/E-mail
Home Cell Email
Permanent Address(If Different from Above)
Street City Zip


Position Desired:
Expected Salary:
Date Available:
Are you related to anyone currently working at CCG Energy Solutions, Inc.?
  Yes      No If so, who?
Have you ever applied for work at CCG Energy Solutions, Inc. before?
  Yes      No If so, when?
How did you hear about this position?
Type of Employment
  Full Time      Part Time
Are you 18 years of age or older?
  Yes      No


Level: Name/Location: Did You Graduate? Degree: Major Areas: GPA:
High School / G.E.D.   Yes
College / University   Yes
Technical School   Yes


In applying for employment, it is understood that we reserve the privilege of contacting past employers regarding references.
May we also contact your present employer?   Yes

Please list most recent employment first.


Company Address Business Telephone Number
From (Mo/Yr) - To (Mo/Yr) Present Title Supervisors Name & Title
Starting Salary Last Salary Reason For Leaving
Duties and Responsibilities
 
Company Address Business Telephone Number
From (Mo/Yr) - To (Mo/Yr) Present Title Supervisors Name & Title
Starting Salary Last Salary Reason For Leaving
Duties and Responsibilities
 
Company Address Business Telephone Number
From (Mo/Yr) - To (Mo/Yr) Present Title Supervisors Name & Title
Starting Salary Last Salary Reason For Leaving
Duties and Responsibilities
 
Company Address Business Telephone Number
From (Mo/Yr) - To (Mo/Yr) Present Title Supervisors Name & Title
Starting Salary Last Salary Reason For Leaving
Duties and Responsibilities


Have you ever been a member of the armed forces of the Unites States?
  Yes      No

If so, describe any special skills or abilities you developed which relate to the job you are seeking:
Can you submit proof of U.S. Citizenship?
  Yes      No

If no, explain.

Note : If hired, you will be required to furnish proof of U.S. Citizenship or your authorization to work in the U.S. as specified under applicable U.S. Immigrations Laws.
Have you ever been convicted under your current name or any other (i) of a felony or (ii) within the past five years of a misdemeanor which resulted in imprisonment? (Note: conviction is not necessarily a bar to employment.)
  Yes      No

If yes, give date, court, nature of offense, and disposition
Date Court Nature of Offense Disposition


PLEASE PROVIDE ANY ADDITIONAL INFORMATION RELATIVE TO THE FOLLOWING QUESTIONS:
Describe the work you expect to be assigned if hired by CCG Energy Solutions, Inc.:
Tell us what specific qualities or attributes you might add to CCG Energy Solutions, Inc.:
State any information that might be helpful in considering this application that is not apparent elsewhere:


Name / Address: Phone: How Acquainted / How Long Business / Title

By submitting this form, you are agreeing to the following:

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 ground for dismissal.

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

I understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature. I also understand and 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 an authorized company representative.”

CCG Energy Solutions, Inc. is a smoke free employer. Smoking and/or the use of tobacco products are not permitted within the company facilities, on company grounds, in company owned vehicles, or at client job sites.

CCG Energy Solutions, Inc. is a drug-free company. All new hires are subject to pre-placement drug screen and background check.