.::Welcome To Errands::.

We are continuously seeking talented, energetic and organized people to be part of our network. Requirements: must have clean driver's license,reliable vehicle, internet access, fax and copy machines.

NETWORK ENROLLMENT FORM
CN ERRANDS SERVICES
72 FAIRFAX DR. CORAM, NY 11727

FIRST NAME

LAST NAME

SSC #

STREET ADDRESS

CITY

STATE

ZIP

E-MAIL ADDRESS

HOME PHONE

CELL PHONE

ARE YOU CURRENTLY EMPLOYED?

IF YES , LIST AGENCY AND DATES .

ARE YOU A U.S CITIZEN OR A LAWFUL PERMANENT RESIDENT?

IF NO , STATE YOUR NON-IMMIGRANT STATUS

ALIEN CARD#

POSITION APPLYING FOR

ARE YOU UNDER 18 YEARS OLD?

IF yes , you are required to provide appropriate work authorization papers.

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDERMEANOR?

IF YES, PROVIDE DATES, CHARGE AND DISPOSITION.

PROFESSIONAL REFRENCES
Please provide the name, title , address and telephone numbers of three professional references we may contact.
Name,Title	Address (City,State,Zip code)	phone	# yr kwn

Acknowledgment & Authorization

I hereby affirm that this application submitted by me for enrollment contain no willful misrepresentations and that the information given is true and Complete. I understand that any false statements or misleading omissions made by me in connection with my application, or in responding to any requests for information, can be sufficient grounds for my rejection as a candidate to join our network or for my immediate termination and /or referral for criminal prosecution. I authorize persons, schools, my current and previous employers and organizations named in this application to provide any relevant information that may be needed to arrive at an enrollment decision.

I agree, if enrolled , to abide by all rules, policies and regulations of C and N ERRANDS SERVICES. I certify that the information that I have provided is complete and accurate.

May we contact your current employer at this time?

If not , when may we contact your employer?

C & N Errands Services is a drug free network.