Customer Service / Billing Specialist Employment Application

Personal Information

EEO Statement - We are an equal opportunity employer, dedicated to a policy of non-discrimination in employment on any basis including age, sex, color, race, creed, national origin, religious persuasion, marital status, political belief, or disability that does not prohibit performance of essential job functions.

Name *

First

Middle

Last

Employment Authorization Statement - Federal law prohibits the employment of unauthorized aliens. All persons hired must submit satisfactory proof of employment authorization and identity (valid driver’s license, birth certificate, Green Card, etc.) within three days of being hired. Failure to submit such proof within the required time shall result in immediate employment termination.

Email *

Phone *

Address *

Address Line 1

City

State

Zip Code

Do you have legible handwriting? *

Do you have good attendance habits? *

Do you possess a high school diploma/GED? *

Can you provide documentation showing your right to work in the USA? *

Are you currently employed? *

If currently employed, may we contact your present employer? *

Are you available for full-time employment? *

Have you ever been convicted of a felony? Yes or No If yes, please explain: *

Have you been convicted of any crime? Yes or No If yes, please explain: *

After reading the job description, is there any requirement that you would not be able to fulfill? *

Education Information - Please list School Name, Location, Years Completed, Degree/Diploma Earned

High School *

College *

Technical Training *

Other Training *

Work History - Please list most recent and most applicable to the position

Company #1 *

Position Held *

Address/City/State *

Dates Employed (From/To) *

Wages/Salary *

Manager/Supervisor *

Phone Number *

Email Address

Reason for Leaving *

Company #2 *

Position Held *

Address/City/State *

Dates Employed (From/To) *

Wages/Salary *

Manager/Supervisor *

Phone Number *

Email Address

Reason for Leaving *

Company #3 *

Position Held *

Address/City/State *

Dates Employed (From/To) *

Wages/Salary *

Manager/Supervisor *

Phone Number *

Email Address

Reason for Leaving *

Skills and Qualifications - Please indicate the level that matches your proficiency (1 star=no experience, 5 stars=proficient)

Microsoft Word *

Microsoft Excel *

Data Input Accuracy *

10 Key (touch) *

Typing (touch) *

Approximately how many words per minute? *

Communications Skills (verbal, phone, email, face-to-face) *

Please describe your qualifications and any specialized training and skills by answering the following.

Describe a good customer experience you provided. *

Describe a data input job you are proud of. *

Describe a task that accuracy mattered to you. *

Describe your critical thinking skills. *

What other skills do you have that we should consider? *

Why should we hire you? *

References - Names and Phone Numbers (please do not include relatives or former employers)

Reference #1 *

Reference #2 *

Reference #3 *

Acknowledgment

The Customer Service Analyst is a full-time position with robust benefits. The position reports directly to the Controller. Condition of hire includes successfully passing a medical and drug/alcohol examination and proficiency tests.

Name *

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements in this application for employment that may be necessary to arrive at any employment decision. This application for employment shall be considered active for a period of time required by law. Any applicant wishing to be considered for employment beyond 45 days should inquire whether or not applications are being accepted. I hereby understand and acknowledge that any employment relationship with this organization is of an “at-will” nature, which means that the Employee may resign at any time, and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at-will employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

Date *

Resume *

Click or drag a file to this area to upload.

Customer Service / Billing Specialist Employment Application

Personal Information

Education Information - Please list School Name, Location, Years Completed, Degree/Diploma Earned

Work History - Please list most recent and most applicable to the position

Skills and Qualifications - Please indicate the level that matches your proficiency (1 star=no experience, 5 stars=proficient)

Please describe your qualifications and any specialized training and skills by answering the following.

References - Names and Phone Numbers (please do not include relatives or former employers)

Acknowledgment

Project RENEWS

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