Employment Application Form

Employment Application Form
All qualified applicants will receive consideration for employment without regard to race, color, creed, sex or national origin. This company offers equal opportunity and treatment to all employees and applicants ALL INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE This application will become a permanent part of your personnel record if you are employed. All instructors, based upon state law and Rules & Regulations of the Georgia Department of Driver Services must have a clean driving record and a background investigation, including fingerprints submitted to the GBI and FBI, and a drug screen prior to licensing.
Applying for which position:*

In-Car Driving InstructorClassroom Driving InstructorBoth In-Car and Classroom Instructor
Are You Currently Licensed or have you ever been Licensed by Georgia Department of Driver Services as a Driving Instructor?*

YesNo
Name*

First NameMiddle NameLast Name
Social Security Number*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Your Current Home Address*

Street Address

Street Address Line 2/Apartment Number/Building Number

CityState / Province

Postal / Zip Code
List Below Address of Residence for Previous Five Years
Past Address*

Street & Number

City

State & ZipFrom (date)

To (date)
Past Address

Street & Number

City

State & ZipFrom (date)

To (date)
Past Address

Street & Number

City

State & ZipFrom (date)

To (date)
Do you speak any foreign languages fluently?*

YesNo
If so, which languages?
Education
High School- Name of School & Location*
Years Attended*
Got Diploma or GED?*
College or University-Name of School and Location
Years Attended
Major or Field of Study
Other Education
Name of Institution and Location
Years Attended
Specialization or Certificate
Employment Record

Be accurate and detail your complete record of past employment. Begin with your current or most recent employer and work back chronologically.
Name of Business, Organization or Agency*
Location*
Specific Work You Did*
Immediate Superior Full Name*
Reason for Leaving*
Dates of Employment? Start Date and End Date*
Most Recent Monthly Earnings*
SalaryComission
Name of Business, Organization or Agency*
Location*
Specific Work You Did*
Immediate Superior Full Name*
Dates of Employment? Start Date and End Date*
Reason for Leaving*
Most Recent Monthly Earnings*
SalaryComission
Name of Business, Organization or Agency*
Location*
Specific Work You Did*
Immediate Superior Full Name*
Dates of Employment? Start Date and End Date*
Reason for Leaving
Most Recent Monthly Earnings*
SalaryComission
Name of Business, Organization or Agency*
Location*
Specific Work You Did*
Immediate Superior Full Name*
Dates of Employment? Start Date and End Date*
Reason for Leaving*
Most Recent Monthly Earnings*
May We Communicate With Your Present Employer?*

YesNo
If not, why?
Driving Record
Do You Have Valid Georgia Drivers License?*

YesNo
If licensed in a different state, which state?
Have you had a Valid Drivers License for 5 consecutive years?*

YesNo
Has your license ever been suspended for revoked in this or any other state?*

YesNo
List approximate dates of revocation or suspension. Mark NA if Not Applicable*
List accidents or traffic violations(no parking) for last six years and Approximate Dates-most recent. Mark NA if not applicable.*
List accidents or traffic violations(no parking) for last six years and Approximate Dates-second most recent. Mark NA if not applicable.*
List accidents or traffic violations(no parking) for last six years and Approximate Dates-third most recent. Mark NA if not applicable.*
Have You Ever Been Charged or Convicted of Any Crime in Georgia or any other state?*

YesNo
If so, in what state?
Have You Ever Worked in this Industry before?*

YesNo
If so, for whom? (name of company)
Reason for Leaving*
Do you have any relatives working for this company?*

YesNo
Personal Data
When are you available for training/employment?*
Please list your nearest living relative
Have you ever been in the Armed Forces?*

YesNo
If so, which branch?
Insurance
List types and amounts of Life and Health Insurance you carry*
Describe your present state of health*
Are you currently under a Doctors care?*

YesNo
Explain
How many times in the past five years, and for what periods, have you been unable to work because of illness?*
Explain
If we have a position in another area, would you be willing to relocate? Explain*
Additional Information
What particular experience and/or ability do you feel qualifies you for a career with our company?*
Applicant's Certification and Agreement
I hereby authorize all my previous employers, or references to furnish any information concerning my personal character, habits or employment records. I hereby release all such persons from liability or damages incurred as a result of inquiry and furnishing this information.
I hereby certify that all statements made in this application for employment are true and correct to the best of my knowledge and belief.
Please verify that you are human*
Should be Empty:

Employment Application Form

List Below Address of Residence for Previous Five Years

Education

Employment Record

Driving Record

Personal Data

Insurance

Additional Information

Applicant's Certification and Agreement