Employment Form

First Name

Last Name

Cell Phone

Street

City

State

Street 2

Zip Code

Position

Position Desired

Hours

Full Time

Part Time

Wages Desired

Date you can start work

Business needs may require any or all of the following: extension of hours, a rotating schedule, Saturday hours, and overtime. Hiring decisions may be made based on your availability as described above.
Please list any hours/days you are not available to work

Information

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Ever applied to this company before

Yes

When

What Department

Are you a citizen of the U.S.?

Yes

If no, do you have a permit to workin the U.S.?

Custom Text

Do you have a valid unrestricted operators license?

Yes

Do you Own or Lease a Car?

Yes

State

Drivers license number

Has your operator's license ever been suspended, revoked or restricted?

Yes

If Yes, when & why

Have you ever been refused surety bond?

Yes

If yes, when and why?

Have you been in an auto accident in the last three years?

Yes

Have you ever been convicted of a crime?

Yes

If yes, describe in full

Have you ever been discharged or asked to resign from a position?

Yes

If yes, when and why

Are you a lay-off and subject of a recall?

Yes

If hired, is there anything which would prevent you from reporting to work each day to perform your job duties?

Yes

If you are under 18, can you furnish a work permit?

Yes

Work time lost last year due to tardiness or absenteeism

Branch of Military Service, if any

Rank

Dates of Service

Show Actual Experience By Checking The Following

Other

If applicable, check in which areas of repair you are certified by the Michigan Department of State

Engine Tune Up

Engine Repair

Brakes, braking systems

Front end and steering systems

Automatic transmission

Electrical systems

Manual transmission and/or axels

Heating and air conditioning

Collision repair

Have you been certified by the National Institute for Automotive Service Excellence (NIASE)?

Yes

Any notice of non-compliance?

Yes

If Yes. what areas?

College

Major/Subject

Number of years

Degree

Highschool

Major/Subject

Number of years

Degree

Other - Including Military Service, Trade or Business Schools

Major/Subject

Number of years

Degree

Most Recent Employer

From: Month/Year

To: Month Year

Name and Address of Employer

Position or Title

Supervisor's Name

Salary Received

Reason for Separation

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Position*

Information*

Show Actual Experience By Checking The Following*

College

Highschool

Other - Including Military Service, Trade or Business Schools

Most Recent Employer

Position

Information

Show Actual Experience By Checking The Following