Staff/Care Center Application

Employment Application for Customer Care Center Positions
St. Louis County Cab Company, Inc. | 9930 Meeks Blvd. | St. Louis, MO 63132
Phone: 314-991-5544 | Fax: 314-754-9405 | countycab.com
*Indicates a required field.
Name:* 
Your Name is required.
Address:* 
A street address is required. 		City:* 
City is required. 		State:* 
State is required. 		Zip:* 
Zip is required.Invalid format.
Primary Phone:* 
A valid phone number is required.Invalid format. 		Secondary Phone: 
Invalid format.
E-mail:* 
A valid email address is required.
Invalid format. Did you forget the @ sign?
How did you hear about us?* 
Please select an item. 		If Team Member, enter name: 
Position applied for?* 
An entry is required. 		Full Time/Part Time:* 
Please select an item.
Days Available:* 
A value is required. 		Hours Available:* 
Please make a selection. 		Date Available:* 
An availability date is required.
Invalid format.
Salary Requirements:*  Are you over 18?* 
Select Yes or No.
Previously employed by us?*        
Select Yes or No. 		If yes, when?    From: mm/dd/yyyy    To: mm/dd/yyyy
Have you previously applied for employment with us?*        
Select Yes or No. 		If yes, when?        
mm/dd/yyyy
If you have relatives employed with us, their name/relationship:
If you would be engaged in any other work while in our employ, please explain:
If hired, can you demonstrate eligibility to work in the United States?*
Select Yes or No.
Have you ever been convicted, pleaded guilty, or pleaded “no contest” to any crime?*
Select Yes or No.
If yes, please explain:  
(A conviction will not necessarily disqualify you from employment.)
To the best of your knowledge would you be able to perform all the essential functions of this position with or without reasonable accommodation?*

Please select an item.
If NO, which functions?
 
 
EDUCATIONAL BACKGROUND
School Name/Address Dates Attended
mm/dd/yyyy		 Date Graduated
mm/dd/yyyy		 Diploma, Degree,
or Certificate		 GPA / Honors
High School*
 
High School name and address is required. 		N/A N/A
  Businesss or Trade Schools
1) From: 
To: 		    
2) From: 
To: 		    
  Colleges or Universities
1) From: 
To: 		    
2) From: 
To: 		    
 
 
INDICATE TRAINING OR EXPERIENCE IN THE FOLLOWING:
Computer Skills:        Windows      Word       Excel      Outlook  
Data Entry:          Keystrokes Per Minute
Call Center:        Average calls per day:      Incoming:      Outgoing:  
Office or other equipment with which you have knowledge or experience:
List any other skills or qualifications not covered by questions above:
 
 
EMPLOYMENT RECORD
Note: List your complete employment record for the last 5 YEARS (including temporary, regular, and part-time) in date order.
List the most recent first. Include military service if applicable.
Last or Current Employer*  ALL fields MUST be completed
Currently employed?  
Select Yes or No. 		If yes, may we contact?  
Select Yes or No.
Name: 
Employer name is required. 		Phone: 

Phone number is required.Invalid format.
Address: 

Employer address is required. 		City: 

City is required. 		State: 

State is required. 		Zip: 

Zip Code is required.Invalid format.
Supervisor’s Name/Title: 
A name is required.
Position Held: 

Please enter your position. 		From: 

Start date is required.Invalid format. 		To: 

End date is required. Enter this month and year if still employed.Invalid format.
Salary: 

A value is required.
Briefly describe your duties:


Please enter a brief job description.
Reason(s) for leaving:


Please enter your reason(s) for leaving.
Second Last Employer
Currently employed?   If yes, may we contact?  
Name:  Phone: 
Address:  City:  State:  Zip: 
Supervisor’s Name/Title: 
Position Held:  From:  To: 
Salary: 
Briefly describe your duties:
Reason(s) for leaving:
Third Last Employer
Name:  Phone: 
Address:  City:  State:  Zip: 
Supervisor’s Name/Title: 
Position Held:  From:  To: 
Salary: 
Briefly describe your duties:
Reason(s) for leaving:
Fourth Last Employer
Name:  Phone: 
Address:  City:  State:  Zip: 
Supervisor’s Name/Title: 
Position Held:  From:  To: 
Salary: 
Briefly describe your duties:
Reason(s) for leaving:
Fifth Last Employer
Name:  Phone: 
Address:  City:  State:  Zip: 
Supervisor’s Name/Title: 
Position Held:  From:  To: 
Salary: 
Briefly describe your duties:
Reason(s) for leaving:
Sixth Last Employer
Name:  Phone: 
Address:  City:  State:  Zip: 
Supervisor’s Name/Title: 
Position Held:  From:  To: 
Salary: 
Briefly describe your duties:
Reason(s) for leaving:
Has a former employer ever disciplined you for tardiness or absenteeism?*  
Please select an item.
If YES, please explain:
If you were employed under a different name in any of these positions, give name and applicable company:
Account for periods of 2 weeks or more in which you have not been working in the last 5 years:
  From  mm/dd/yyyy To  mm/dd/yyyy Reason
1) 
2) 
3) 
4) 
 
ACKNOWLEDGEMENT OF UNDERSTANDING AND CONSENT
To be read and signed by Applicant

It is understood that this application is not an obligation of employment.

I hereby authorize St. Louis County Cab Company, Inc. to investigate all references and former employment, and I release from liability those supplying such information.

I will provide proof of my eligibility to work as required by “The Immigration Reform and Control Act of 1986”.

I understand that St. Louis County Cab Company, Inc. can make no guarantee as to the number of hours that I may be assigned from week to week, and any reduction in hours can affect my compensation and benefits. I also understand that I may be required to change days off and scheduled hours on a temporary or regular basis in order to continue my employment. Also, I understand that St. Louis County Company, Inc. reserves the right to transfer me, as business necessitates, and my continued employment may be predicated upon my acceptance of said transfer. I understand that evenings or weekends may be part of any schedule I may be assigned.

I understand that my employment is not governed by any written or oral contract and is considered an “at will” arrangement. I understand that I am free, as is St. Louis County Cab Company, Inc., to terminate employment at any time for any reason, so long as there is no violation of applicable Federal or State law.

I state that the information on this application is true and complete. False statements,
misrepresentations, or omission may be cause for cancellation of an employment offer or termination if already employed. This Notice does not permit the release or use of disability-related or medical information in a manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws. I agree that I have read and understand the above acknowledgements and agreements and recognize all of the above as conditions of employment.

THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I am aware of the requirements of the position.
Today’s Date:* 
Please enter today’s date.Invalid format.

 

Applicant Signature: ________________________________
(To be physically signed at time of interview. Submission of this application form will be considered an electronic signature.)
Verification Code:  
Enter Verification Code:*  
 
Please review ALL information entered BEFORE you submit this form. NO CHANGES can be made after submission. A copy of your completed application will be emailed to the address you provided above.