Auto Rust Technicians

Employment Application

Name
Present address, city, state
Permanent address, city, state
Primary phone number		Cell Home Work
Secondary phone number		Cell Home Work
Date of Birth
Email

Position applying for
Expected pay
Date you can start
Time available	Morning Afternoon Evening
Are you looking to work full or part-time?	Full Time Part Time Either
Are you legally authorized to work in the US?	No Yes
Have you ever been convicted of a felony?	No Yes
Have you applied to work here before?	No Within the past year More than a year ago

	Name & location of school	Years attended	Did you graduate?	Subjects studied
High School			No Yes
College			No Yes
Other school			No Yes

Have you studied anything extensively outside of school?
Have you had any other special training?
Do you have any other relevant skills or experience?
Have you served in the US armed forces?
What languages are you fluent in?

Are you currently employed?	No Yes
Current or most recent employer	Date started & ended	to
	Company name & location
	Start & end pay rate	to
	Start & end position	to
	Reason for leaving
	Supervisor name & phone
	May we contact your supervisor?	No Yes
Previous employer	Date started & ended	to
	Company name & location
	Start & end pay rate	to
	Start & end position	to
	Reason for leaving
	Supervisor name & phone
	May we contact your supervisor?	No Yes
Previous employer	Date started & ended	to
	Company name & location
	Start & end pay rate	to
	Start & end position	to
	Reason for leaving
	Supervisor name & phone
	May we contact your supervisor?	No Yes

Reference #1	Name
	Phone
	How do you know this person?
	How long have you known this person?
Reference #2	Name
	Phone
	How do you know this person?
	How long have you known this person?
Reference #3	Name
	Phone
	How do you know this person?
	How long have you known this person?

Who referrered you to this opening?
What can you contribute to our team?
Is there anything else you'd like to add?

"I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be grounds for immediate dismissal and forfieture of any unemployment benefits.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information regarding my previous employment and any pertinent information that they may have, pertinent or otherwise, and release the company from all liability from any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act and other relevant federal and state laws."

I understand and affirm the above statement.