Employment Application Form

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

APPLICANT'S STATEMENT

I understand that if I am hired, my employment will be for no definite period, regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time with or without notice, and the company has the same right. No one other than the President of the Company has the authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be in writing.

I understand that the Company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I authorize the Company to investigate my education history, my driving record, my credit history, and my criminal record. I further understand that the Company may contact my previous employers and I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers and I agree to hold it harmless for providing such information.

By signing below, I certify that all of the information that I provide on this application and in any interview will be true, complete, and accurate. I understand that if I am employed and any such information is later found to be false or misleading in any respect, I will be dismissed.

***AUTHORIZATION TO OBTAIN CONSUMER REPORTS***

IT HAS BEEN DISCLOSED TO ME THAT THE COMPANY MAY OBTAIN ONE OR MORE CONSUMER REPORTS ON ME FOR USE IN CONNECTION WITH MY APPLICATION OR FOR OTHER EMPLOYMENT-RELATED PURPOSES. THESE REPORTS MAY INCLUDE CREDIT BUREAU REPORTS, CRIMINAL RECORDS, AND DRIVING RECORDS. I AUTHORIZE THE COMPANY OR PERSONS ACTING ON ITS BEHALF TO OBTAIN THESE REPORTS.
Name*

First NameMiddle NameLast Name
Date*

MonthDayYear
Date
What position are you applying for?
What location are you applying for?
Signature

Clear

PERSONAL INFORMATION:
Name:*

First NameLast Name
Birth Date

MonthDayYear
Social Security No.*
License No:
State:
Expiration Date:
Phone Number:*

Area CodePhone Number
E-mail Address:
Current Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived here?
Previous Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long did you live there?
Have you ever worked for Joe Bullard before?

YesNo
If Yes, when:
Do you have any friends or relatives working here?

YesNo
If Yes, who and what is your relationship
Have you ever pled guilty or "no contest" to a crime or been convicted of a crime?

YesNo
Do you have any criminal charges pending?

YesNo
If yes to either question, please give dates and details of each:

Record of Previous Employment

Please list your three most recent employers in chronological order with the present employer listed first.
Have you ever been terminated or asked to resign from any job?

YesNo
If Yes, please explain why:
Please explain fully any gaps in your employment history:
Previous Experience

Please indicate any actual experience that you have had in any of the following positions.
Office
Sales
Service and Parts
Technician Applicants: Please list all the current ASE certifications as well as any other special technician qualifications:
Please list your previous education and highest grade completed:
High School
College
Graduate School
Trade School or Correspondence
Any other form of School

Emergency Information

In case of an accident or any other emergency, who should we contact?
Name:
Relationship:
Phone Number

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
References:

Please list two (2) references that are familiar with your work life.
Reference 1:
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2:
Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry