Name*

Email*

Address*

City*

Prov/State*

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Zip/Postal Code*

Phone*

Are you at least 18 years of age?

Yes  No

Have you been employed with CUC before?

Yes  No

If Yes, Dates and Location

Reason for Leaving

Are you prepared to work full time and/or overtime, if necessary?

Yes  No

If No, Please comment

Did you graduate from High School?

Yes  No

Highest Grade Completed

--Select-- 1 2 3 4 5 6 7 8 9 10 11 12 College 1 College 2 College 3 College 4

Last School Attended

Technical School or Training

Are you on layoff or subject to recall?

Yes  No

If yes, from where

Resume

Former Employment
(include titles and tasks)

References