• Address
• City
• State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• How long at current address?
• Email
• Daytime Phone
• Home Phone
• Position for which you are applying, include Job listing number:
• Check the following options you would consider Full Time Part Time Temporary
• If part time, specify hours or days
• Your minimum salary requirement ($)
• Date available for work
• Do you have any commitments to another employer that might affect your employment with us?

	SCHOOL NAME	CITY AND STATE	DEGREE/DIPLOMA MAJOR COURSE OF STUDY	DEGREE RECEIVED?
High School/ GED				Yes NO
College				Yes NO
Graduate School				Yes NO
Trade School				Yes NO

List any other education, training, special skills or certificates/licenses that you possess that is related to the job.

Professional License/ Cerfification#	Professional License/ Certification Type	Issuing Agency	State Issued	Expiration Date

List any machines, equipment or software programs on which you are qualified and experienced in operating.
List any languages that you speak fluently: Read/Write:
If you are applying for a position which involves driving a motor vehicle in the course and scope of the employment duties, please indicate whether you have a valid driver's license in this state. Yes NO
Military Experience? Yes NO
If yes, what branch? Rank at separation

Can you, after employment, submit verification of your legal right to work in the United States?	Yes NO
Are you at least 18 years of age?	Yes NO
Were you previously employed by CREST Services? If yes, give dates:	Yes NO
Do you have any relatives working for CREST Services? If yes, list names:	Yes NO
Can you perform the essential functions of the job?	Yes NO

List all work experience beginning with the present or most recent job (use back of application, if necessary).

• Name of Employer
• Type of Business
• Address
• City
• State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• Dates Employed From (month/year) – To (month/year)
• Title
• Name and Title of Supervisor
• Telephone Number
• May We Contact? Yes No
• Type of Employment Part Time Full Time Temporary
• Brief Description of Duties
• Reason for Leaving
• Last Salary($)

• Name of Employer
• Type of Business
• Address
• City
• State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• Dates Employed From (month/year) – To (month/year)
• Title
• Name and Title of Supervisor
• Telephone Number
• May We Contact? Yes No
• Type of Employment Part Time Full Time Temporary
• Brief Description of Duties
• Reason for Leaving
• Last Salary($)

• Name of Employer
• Type of Business
• Address
• City
• State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip
• Dates Employed From (month/year) – To (month/year)
• Title
• Name and Title of Supervisor
• Telephone Number
• May We Contact? Yes No
• Type of Employment Part Time Full Time Temporary
• Brief Description of Duties
• Reason for Leaving
• Last Salary($)

(List three individuals, in addition to listed employment references, known to you for at least three years.)

NAME	OCCUPATION / ASSOCIATION	TELEPHONE
1.
2.
3.

Please include any other information you think would be helpful to us in considering you for employment, such as additional work experience, articles/books published, activities, honors received, etc. (You may omit all information that would indicate age, sex, sexual orientation, race, religion, color, national origin, or disability.)

All Applicants: Exclude any records expunged, annulled, sealed, or discharged under first-offender law.
Massachusetts Applicants: An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to an inquiry herein relative to prior arrests, criminal court appearances, or convictions. In addition, any applicant for employment may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances, and adjudications in all cases of delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution. The applicant may exclude a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray or disturbance of the peace. The applicant may exclude any convictions of misdemeanors which are more than five years old.
California Applicants: You may exclude misdemeanor marijuana convictions if such convictions are more than two years old and you may also exclude referrals to and participation in pre and post trial diversion programs.
Hawaii Applicants: Do NOT answer the criminal record questions.
Except as provided above, during the past ten years, have you ever been convicted of, plead guilty to, or received probation, deferred adjudication, or any other type of alternative method of supervision or correction for a misdemeanor, having a penalty of imprisonment or a fine of more than $500, or a felony? (Answering yes is not an automatic bar to employment but will be considered in relation to specific job requirements.) Yes No
If yes, explain: ?????
Have you been convicted of a crime (exclude minor traffic cases; include DUIs)? Yes No
If yes, describe: ?????
Are criminal charges now pending against you? CA applicants should only answer this question if you are currently out on bail or out on your own recognizance pending trial. Yes No
If yes, describe: ?????

AGREEMENT (Please read the following statement carefully.)

I hereby affirm that the information provided on this application (and accompanying resume, if any) is true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date.

I authorize all persons listed above (and on the accompanying resume, if any) to give CREST Services any and all information concerning my previous employment and education and any pertinent information they may have, personal or otherwise, and release all parties, such persons and CREST Services, from liability for any damage that may result from furnishing same to CREST Services.

I understand that CREST Services will provide workers' compensation insurance coverage for its employees. In the event of an injury in the workplace, I agree that my sole remedy lies in coverage under CREST Services' workers' compensation insurance policy.

If employed by CREST Services, I agree to abide by the policies and procedures of CREST Services, which include CREST Services' Anti-Harassment Policy. I further understand that my employment can be terminated, with or without cause or notice, at any time, at the discretion of CREST Services or myself. I further understand that no manager or representative of CREST Services other than the president of CREST Services has any authority to enter into any agreement, oral or written, on behalf of CREST Services for a term of employment or to make any assurance or promise of continued employment.

I understand that CREST Services may obtain a consumer and/or investigative consumer report for employment purposes that may include information regarding prior employment, work experience and performance, reasons for employment termination, and information as to character, general reputation, personal characteristics, or mode of living. The report may also contain a records check of driving, criminal, credit, education, degrees, professional licenses and/or certification records depending on the position. By signing this application, I authorize the procurement of a consumer and/or investigative consumer report by CREST Services as part of the pre-employment background investigation and if hired, at any time during my employment. California Applicants: I further understand that CREST Services may obtain Public Records about me as part of an internal background investigation and that I may waive my right to receive a copy of such Public Records by checking this box:

UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.

I understand and agree that I may be required to take a drug and alcohol screening test. I hereby give my voluntary consent for a blood and/or urine sample to be collected from me and submitted for testing. I also consent to the release of the test result to CREST Services for its use. I understand that any positive drug or alcohol result may preclude my employment.

I agree I deny