Application For Employment

Personal Info:


School Attended

Course of Study

Years Completed

Diploma or Degree


Please list any certifications you may have.

Military Service:

Have you had job related training in the United States military?

If yes, please describe.

Employment History:

Start with the most recent or present employer - including Military Service.

Job Title and Description of Duties:

Reason for Leaving:

What is your annual salary expectation for this position?

Professional Activities

List professional, trade, or business activities and offices held.

Special Skills and Qualifications/Other Job Related Training

Summarize special job-related skills and qualifications acquired from employment or other experience.

Are you 18 years of age?

Are you authorized to work in the United States?
Proof of current authorization to work will be required upon employment.

Have you previously filed an application with Citizens?
If yes, give the date (s).

If you receive a conditional offer of employment, will you submit to the post offer physical assessment for the job offered and a test for the illegal use of drugs, at the expense of Citizens?

Have you been disciplined, or involuntarily separated by an employer in the past 5 years?
If yes, please explain.

Have you been convicted of a felony?
Conviction will not necessarily disqualify a candidate/applicant from employment.
If yes, please list conviction date and type of conviction.

May we conduct a detailed reference check?
If yes, please indicate any employers you do not want us to contact and reason.

Are you related to anyone working at Citizens or Member of the Board of Directors?
If yes, please list.

Where did you hear about this job?


Give name, address, and telephone number of three references who are not related to you.



Phone Number

Cover Letter

Please upload your cover letter


Please upload your Resume

I have read and understand the Candidate's/Applicant's Certification and Agreement and certify the information I have provided in my employment application is true and complete.