Personal Data
Date: 
Name:
Social Security Number:
Position Applying for:
Address:
City:
State:
Zip:
E-Mail:
Home Phone:
Message Phone:
Do you have a valid driver's license?  Yes  No
License No: 
  Exp. Date: 

Do you have adequate transportation to and from work?  Yes  No
Have you been cited for a traffic violation of any kind within the past FIVE years? 
Yes  No
     If yes, please give date and details:

 
Education
Elementary School Name:  Years Completed: 
High School Name:  Years Completed: 
College/University School Name:  Years Completed: 
Graduate/Professional School:  Years Completed: 
Diplomas or Degrees:
Describe Course of Study or Major: 
Describe Specialized Training, Military Experience, Skills & Extracurricular Activities:

 
Record of Previous Employment

Please list the names of your previous employers in chronological order with present or last employer listed first.  Be sure to account for all period of time including military service and any period of unemployment.  If you were self-employed, give the business name and supply business references.   Email extra information, if necessary.
Present or Last Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone: 
Reason for Leaving: 
Previous Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone:
Reason for Leaving: 
Previous Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone: 
Reason for Leaving: 
Previous Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone: 
Reason for Leaving: 
Previous Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone: 
Reason for Leaving: 
Previous Employer: 
       Your Title or Position: 
From (mo/yr): 
Starting Salary: 
To (mo/yr): 
Present/Ending Salary: 
Address: 
City:  State  Zip 
Name of Last Supervisor Telephone: 
Reason for Leaving: 

 
References

List professional references who are familiar with the quality of your work, have worked with you and have known you for at least two years.
REFERENCE 1:
Name:
Occupation:
Address:
Telephone:
Years Known:
REFERENCE 2:
Name:
Occupation:
Address:
Telephone:
Years Known:
REFERENCE 3:
Name:
Occupation:
Address:
Telephone:
Years Known:

 
 
 
Additional Information

Have you ever been terminated or asked to resign from any job?  Yes   No
If yes, explain the circumstances:

Please explain any gaps in your employment history:

May we contact your most current employer?  Yes   No

Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor or felony?
Yes   No
If yes, give details and dates of each:

Have you been arrested for any matter for which you are out on bail or on your own recognizance pending trial?
Yes   No
If yes, explain the circumstances:

 
 
Please check any of the following areas or positions that you have held and indicate actual work experience in each:
DESCRIPTION
EXPERIENCE

Administration		  
Accounts Payable
Accounts Receivable
Bookkeeper
Cashier
Computer Accounting
Data Entry
Financial Analysis
Financial Statement
Insurance Claims
Job Costing
Office Manager
Payroll Clerk
Real Estate
Receptionist
Tax Returns
Warranty Clerk
Word Processing
Sales
Customer Service Rep
Department Sales Manager
Leasing Manager
Phone Sales
Regional Sales Manager
Salesperson (New Car)
Salesperson Retail
Salesperson Service
Salesperson (Used Car)
Salesperson Wholesale
Production
ABS Brakes
Air Bag Systems
Air Conditioning
Apprentice/Helper
Automotive Electrical
Body Technician
Color Matching
Cooling Systems
Computerized Paint Mixing
Dedicated Jig Systems
Detailer
Exhaust Systems
Frame Technician
Glass Installation
Machine Polishing
Maintenance
Mechanic
Mig Welding
Oxy/Acetylene Welding
Paint Preparation
Plastic Repair
Refinish Technician
Suspension & Steering
Universal Bench Systems
Wheel Alignment
Other
Advertising/Marketing
Department Manager
Estimator
Insurance Adjuster
Insurance Appraiser
Inventory Control
Parts Counter Person
Parts Manager
Production Manager
Purchasing Agent
Service Manager
Service Writer/Advisor
Shop Foreman
Shop Manager
Remarks and Special Qualifications:
(Please include any computer systems and programs with which you are familiar.)

 
I hereby certifiy that all of the information that I have provided on this application is true and correct.
Date:            Electronic Signature: