Type of Employment Desired

Specific position(s) applied for: Min Salary Expected: $

Date Available:

Applying for :
Full-Time
Part-Time
Temporary
Seasonal

Referral Source: Please Select One Advertisement Friend Employment Agency Relative Other

Personal
In compliance with Federal and State Equal Opportunity laws and the policy of CSC, new employees are selected and current employees promoted on the basis of qualifications without regard to race, color, religion, sex, national origin, age, disability veteran status, or any other status legally protected by applicable Federal, state and local law. CSC complies with Government regulations with respect to hiring the handicapped (Ref. Section 503 of the Rehabilitation Act 1973, Sec. 402 of the Vietnam Era Veterans Readjustment Assistance Act of 1974, and the Americans with Disabilities Act of 1990).

Name
Last Name: First: Middle Initial:

Address
Street: City: State: Zip Code:

Telephone: Mobile/Beeper/Other Phone:

Social Security Number: Email Address:

If you are under 18, can you furnish a work permit? Yes No

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? (Proof of citizenship or immigration status will be required upon employment.) Yes No

To the best of your knowledge have you ever been employed by CSC or its subsidiary companies? Yes No
If yes, explain:

Do you have relatives who are employed by CSC or its subsidiary companies? Yes No
If yes, list names, locations, and relationship:

Have you ever held a security clearance? Yes No
If yes, state level and granting agency:

Have you ever been convicted of a felony? Or, have you been convicted of a misdemeanor which resulted in imprisonment? (Do not include traffic violations for which the only penalty imposed was a fine) Record of conviction does not disqualify you from employment consideration. Yes No
If yes, please explain:

References

1 - Reference One
Name: Telephone:
Address: Position:

2 - Reference Two
Name: Telephone:
Address: Position:

3 - Reference Three
Name: Telephone:
Address: Position:

Employment Background
List all employment in the last ten years, or since graduation beginning with your present or most recent position. Include military assignments and volunteer activities or any other experience you believe to be relevant to the position for which you are applying.

1 - Present or Last Employer:
Employer: Telephone:
Address:
Immediate Supervisor: Title:
May we contact supervisor for reference? Yes No
If yes, Telephone:
Dates Employed: (mm/dd/yy) From: To:
Hourly Rates / Salary Starting: $ per
Hourly Rates / Salary Final: $ per
Other Compensation: (Give details on commissions, incentives, bonuses, etc.)

Your current or last position:
Duties:

Your starting position:
Duties:

Reason for Leaving:

2 - Next Most Recent Employer:
Employer: Telephone:
Address:
Immediate Supervisor: Title:
May we contact supervisor for reference? Yes No
If yes, Telephone:
Dates Employed: (mm/dd/yy) From: To:
Hourly Rates / Salary Starting: $ per
Hourly Rates / Salary Final: $ per
Other Compensation: (Give details on commissions, incentives, bonuses, etc.)

Your current or last position:
Duties:

Your starting position:
Duties:

Reason for Leaving:

3 - Next Most Recent Employer:
Employer: Telephone:
Address:
Immediate Supervisor: Title:
May we contact supervisor for reference? Yes No
If yes, Telephone:
Dates Employed: (mm/dd/yy) From: To:
Hourly Rates / Salary Starting: $ per
Hourly Rates / Salary Final: $ per
Other Compensation: (Give details on commissions, incentives, bonuses, etc.)

Your current or last position:
Duties:

Your starting position:
Duties:

Reason for Leaving:

4 - Next Most Recent Employer:
Employer: Telephone:
Address:
Immediate Supervisor: Title:
May we contact supervisor for reference? Yes No
If yes, Telephone:
Dates Employed: (mm/dd/yy) From: To:
Hourly Rates / Salary Starting: $ per
Hourly Rates / Salary Final: $ per
Other Compensation: (Give details on commissions, incentives, bonuses, etc.)

Your current or last position:
Duties:

Your starting position:
Duties:

Reason for Leaving:

Education
List High School, Colleges, Military or Trade Schools.

1 - School One
Name: Years Completed: Degree/Diploma:
GPA / Class Rank: Major:

2 - School Two
Name: Years Completed: Degree/Diploma:
GPA / Class Rank: Major:

3 - School Three
Name: Years Completed: Degree/Diploma:
GPA / Class Rank: Major:

Military Service Recap

Branch: Highest Rank: Speciality:

Comments and Accomplishments:
Explain here primary skills and areas of specialization which may assist in the evaluation of your qualifications. Include awards, patents, publications, typing/keyboard/shorthand speed, computer software experience, office machines you are capable of operating, etc. You may exclude any which indicate race, national origin, creed, color, or ancestry of its members.

List trade, professional, extracurricular activities, scholarships, volunteer organizations and professional or technical
certifications obtained:

If you wish to submit a resume please send it to applycsc@fortcarsonsupportservices.com

Terms and Conditions

I certify that the answers given herein are true and complete to the best of my knowledge and belief.

If an employment relationship is established, I understand that I have the right to terminate my employment at any time, with or
without cause, and that CSC retains the same right. Further, I understand that false or misleading information given in this
application or interview(s) may be considered grounds for dismissal. I understand also that I am required to abide by all rules
and regulations of the Company.

I authorize CSC to make investigations of all statements contained in this application and other related matters as may be
necessary in arriving at any employment decision, and I indemnify CSC against any liability which might result from making
such investigations and inquiries. I hereby release employers, schools, businesses and governments or persons from any
liability in responding to inquiries in connection with my application.

This application will remain valid until the position applied for is filled by CSC, or for a period of one year, whichever comes
sooner. To receive any further consideration after such period, a new application should be filed.

I certify that I have read and understand all terms of this employment application.