John

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Position Desired

Placement Desired

Please list the names of your previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service and any period of unemployment. If self-employed, give firm name and supply business references.

Your Title or Position

Present or last employer

Address

City, State, Zip

Telephone

Starting Pay

Final Pay

Your Title or Position

Reason for Leaving

Previous Employer

Address

City, State, Zip

Telephone

Employed From (mo./yr.) to (mo.yr)

Starting Pay

Final Pay

Your Title or Position

Reason for Leaving

Previous Employer

Address

City, State, Zip

Telephone

Employed From (mo./yr.) to (mo.yr)

Starting Pay

Final Pay

Your Title or Position

Please explain fully any gaps in your employment history:

Have you ever been terminated or asked to resign from any job?

If yes, please explain circumstances:

May we contact your current employer?

If no, please explain:

Emergency Information

In case of an accident or other emergency, who should we contact?

Name

Relationship

Home Address

City, State, Zip

Telephone (Home)

Telephone (Work)

Work Address

City, State, Zip

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Character References

Please list persons who know you well - Not previous employers or relatives

Name

Occupation

Address

Telephone

No. of yrs. known

Name

Occupation

Address

Telephone

No. of yrs. known

Name

Occupation

Address

Telephone

No. of yrs. known

Driving Information

(complete only if you will drive a vehicle in connection with your employment)

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Do you have a valid driver's license?

If yes, License No:

State

Exp. Date

Has your license ever been suspended or revoked?

If yes, please explain:

Do you have personal automobile insurance?

If yes, please explain:

Have you ever been denied personal automobile insurance or has it ever been terminated or suspended?

If yes, please explain:

Have you ever been convicted, pled guilty or nolo to a charge or DWI or DUI?

Are any such charges currently pending against you? If yes, explain:

Please list all moving traffic violations in the last five (5) years:

Offense:

Location:

Date:

Comments

Offense:

Location:

Date:

Comments

Additional Information

Please indicate any actual experience you have in any of the following positions:

Office

Sales/Leasing

Service and Repair

Parts

Personal Data

Name

SS#

Present Address

City, State, Zip

How long have you lived there? (yrs./mos.)

Previous Address

City, State, Zip

How long did you live there? (yrs./mos.)

Telephone

Are you 18 years of age or older?

Have you ever worked for this company before?

If yes, please give dates and position:

Do you have any friends or relatives working?

If yes, name:

Do you have a reliable means of transportation to travel to and from work which will allow you to consistently arrive at work on time?

Note: An affirmative answer to the following questions will not automatically disqualify you from consideration for the position for which you are applying. Factors such as age of the conviction, time of events, seriousness and nature of the violation, and rehabilation are taken into account.

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Have you ever pled guilty or "no contest" tp a crime or been convicted of a crime?

If yes, please give date and details of each:

Have you ever had an adjudication in a criminal case withheld?

If yes, please give date and details of each:

Do you currently have any criminal charges pending against you?

If yes, please give date and details of each:

If hired, can you provide proof that you are legally entitled to work in the U.S.?

Do you have any commitments to any other employer which may affect your employment?

If yes, explain:

High School Attended

Highest grade completed:

College Attended:

Years completed in college? (Attending, Associates degree, Bachelor's degree, etc.)

Military experience or other certifications: