Capitol Pool Service, Inc.

Employment Application

Capitol Pool Service Employment Application

Personal Information

The Job


Yes No

CPS will require a DMV Driving Record

Yes No

Yes No

Do you have any chronic illnesses of which we should be aware?

Previous Employment Experience

From Until Employer Position/Salary Supervisor Contact Reason for Leaving

Emergency Contact Information

Name: Phone #: Relationship:

Please Read Carefully

Applicant's Certification and Agreement

By submitting this application I hereby certify that the facts set forth in the above Employment Application are true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be considered cause for dismissal. I agree that, should less than two weeks notice be given before quitting, up to one week of salary may be withheld by CPS to pay for the costs of replacement.

Please Email us at: CPS Email
Phone us at: 301-608-1100 or 703-288-0200