Centerville Auto Application Form

PLEASE NOTE: It is important that you complete all parts of the application. If your application is incomplete or does not clearly show the experience and/or training required, your application may not be accepted.
PERSONAL INFORMATION
Full Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Email
example@example.com
If under 18, please list age
JOB TYPE
Days/hours available to work
Employment Desired
Position
Hourly Desired $
How many hours can you work weekly?
Can you work nights?
Date You Can Start

MonthDayYear
ADDITIONAL INFORMATION
Have you ever been employed by this organization in the past?
I certify that I am a U.S. citizen, permanent resident, or a foreign national with authorization to work in the United States.
Have you ever been convicted of, or entered a plea of guilty, no contest, or had a withheld judgment to a felony?
If Yes, please explain
Do you have a driver's license?
Driver's license number
Issued in what state?
Have you had any accidents during the past three years?
How many?
Have you had any moving violations during the past three years?
How many?
EDUCATION
High School/GED
Name of High School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Degrees
College
Name of College/University Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Majors/Degrees
Post-Grad
Name of Graduate School Attended
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Years Completed
Did you graduate?
Majors/Degrees
WORK EXPERIENCE

List below your last 3 employers, starting with the most recent.
Previous Employer 1
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact this employer?
Previous Employer 2
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
End Date

MonthDayYear
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact this employer?
Previous Employer 3
Name of Previous Employer
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Hourly (Upon Leaving)
Reason for Leaving?
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
May we contact this employer?
REFERENCES

Please include name, phone number, and circumstances of your acquaintance. Exclude relatives and former employers.
Reference 1
Name of Reference
Relationship
Years Acquainted
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 2
Name of Reference
Relationship
Years Acquainted
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reference 3
Name of Reference
Relationship
Years Acquainted
Phone

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AUTHORIZATION
I certify that all answers and statements on this application are true and complete to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be rejected or my employment with this company terminated.
Signature
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

PERSONAL INFORMATION

JOB TYPE

ADDITIONAL INFORMATION

EDUCATION

WORK EXPERIENCE

REFERENCES

AUTHORIZATION