Auto Parts & Supplies Job Application

Auto Parts & Supplies Job Application
It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications.

Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the application. You may attach a résumé, but all questions must be answered. questions o n th is
Employer
Position applying for*
PERSONAL DATA
Name*

First NameMiddle NameLast Name
Address*

Street Addressand/or Mailing Address

Street Address Line 2

CityState

Zip
Home Telephone Number*
Business Telephone Number
Cellular Telephone Number
Date you can start work*

MonthDayYear
Date
Salary Desired*
Do you have a High School Diploma or GED?*

YesNo
POSITION INFORMATION
Check all that you are willing to work*

Hours: Full TimeHours: Part TimeHours: DaysHours: EveningsHours: Swing Graveyard WeekendsHours: GraveyardHours: WeekendsStatus: RegularStatus: Temporary
Are you authorized to work in the U.S. on an unrestricted basis?*

YesNo
Have you ever been convicted of a felony? Convictions will not necessarily disqualify an applicant for employment*

YesNo
If yes, explain*
Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functions of the job?*

YesNo
Can you perform these essential functions of the job with or without reasonable accommodation?*

YesNo
QUALIFICATIONS

Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training.

	School Name	Degree	Address/City/State
School
School
Other

SPECIAL SKILLS
List any special skills or experience that you feel would help you in the position that you are applying for (leadership, organizations/teams, etc.)
REFERENCES

Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references.

	Name	Address/City/State	Phone	Relationship

WORK HISTORY
Start with your present or most recent employment and work back. (INCLUDE PAID AND UNPAID POSITIONS)

Job #1
Job Title #1
Start Date (mo/day/yr)

MonthDayYear
Date
End Date (mo/day/yr)

MonthDayYear
Date
Company Name
Supervisor’s Name
Phone Number
City
State
Zip
Job #1 - Duties
Reason for Leaving
Starting Salary
Ending Salary
May we contact your present employer?

YesNoN/A

Job #2
Job #2 - Title
Job #2 - Start Date (mo/day/yr)

MonthDayYear
Date
Job #2 - End Date (mo/day/yr)

MonthDayYear
Date
Job #2 - Company Name
Job #2 - Supervisor’s Name
Job #2 - Phone Number
Job #2 - City
Job #2 - State
Job #2 - Zip
Job #2 - Duties
Job #2 - Reason for Leaving
Job #2 - Starting Salary
Job #2 - Ending Salary

Job #3
Job #3 - Title
Job #3 - Start Date (mo/day/yr)

MonthDayYear
Date
Job #3 - End Date (mo/day/yr)

MonthDayYear
Date
Job #3 - Company Name
Job #3 - Supervisor’s Name
Job #3 - Phone Number
Job #3 - City
Job #3 - State
Job #3 - Zip
Job #3 - Duties
Job #3 - Reason for Leaving
Job #3 - Starting Salary
Ending Salary

Jobs End
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed,
false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation of any of the facts set forth
in this application and release the Employer from any liability. The employer may contact any listed references on this application.

I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category
employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with or without cause,
with or without notice to the other party
Signature*

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Date

MonthDayYear
Date
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Auto Parts & Supplies Job Application

PERSONAL DATA

POSITION INFORMATION

QUALIFICATIONS

SPECIAL SKILLS

REFERENCES

WORK HISTORY