Apply For A Position

General Information
Your full Name*
First Last
Your Phone Number*
Todays Date*
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are You 18 Years Or Older?*
- Yes
- No
Are You Bilingual?
- Yes
- No
Are you legally authorized to work in the United States?*
- Yes
- No
How did you hear about Clark County Collection Service?*

Miscellaneous
Have you ever been convicted of a misdemeanor or felony?*
- Yes
- No
Please provide date of conviction, state and county, and describe circumstances.*
*A conviction is not an automatic bar to employment. The type, seriousness, frequency of violations, relevancy, work history, education and other circumstances will be considered.

Previous Employer
Name Of Employer
Position
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Supervisor
Reason For Leaving
Dates Employed From:
Dates Employed To:
Brief Description Of Your Work And Responcibilities
May We Contact this Employer
- Yes
- No

Your References
Reference 1
Reference Name*
Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
Years Known And In What Capacity*
Can We Contact This Reference?*
- Yes
- No
Reference 2
Reference Name
Phone Number
Address
Street Address Address Line 2 City State ZIP Code
Years Known And In What Capacity

AUTHORIZATION AND UNDERSTANDING

• I certify the information given by me is true in all respects.

• I understand that the misrepresentation or omission of facts on this application, on my resume or during any stage of the hiring process will eliminate me from further consideration or if discovered after hire may result in the termination of my employment.

• I understand that the information contained in this employment application or my being invited to participate in any stage of the hiring process is NOT intended to create an employment contract between this Company and myself. If an employment relationship is established, I understand that I have the right to terminate my employment at any time, for any reason or no reason, with or without notice, and this Company has the right to terminate my employment at any time, for any reason or no reason, with or without notice. This Company’s policies and procedures, including employment at-will, cannot be modified in any way without express written intent to do so by the President of this organization.

• I understand that an offer of employment is contingent on my providing sufficient documentation necessary to establish my identity and eligibility to work in the United States.

• I authorize this Company and its representatives to contact my prior employers, former supervisors and company personnel, schools and all others for the purpose of verifying the information I have supplied during the selection process and for obtaining job-related information regarding my knowledge, skills, abilities, performance of duties and compliance with policies. I authorize my prior employers to provide this Company any job-related information, personal or otherwise, they may have regarding me and I release this Company and them from any liability resulting from the release of this information. I further authorize all employers, schools and other persons to provide any information or transcripts that may be requested by this Company which will be used to determine if I am qualified to perform the job duties for which I am applying.

By signing below, I acknowledge that I have read, understand and agree with the above statements.
Your E-Signature*
Todays Date*

Step 1 of 7

General Information

Employment Desired

Miscellaneous

Please List Your Education

Previous Employer

Your References

Reference 1

Reference 2

AUTHORIZATION AND UNDERSTANDING