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Preventative Tire Maintenance Group Employment Form

General Information:
Date:*
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Name:*
Social Security Number:
Primary Phone:*
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Second Phone:
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E-mail:
Applicant Note:
This application form is intended for use evaluating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination based on sex, marital status, race, color, age, creed, national origin, sexual orientation, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. A conviction will not necessarily bar an applicant from employment. Additional testing of job-related skills for the presence of drugs in your body may be required prior to employment. After an officer of employment, and prior to reporting to work, you may be required to submit to a medical review. Depending on company policy and the needs of the job, you will be required to complete a medical history form and may be required to be examined by a medical professional designated by the company.
Address:
For what position are you applying for?*
What date can you start?
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What category would you prefer?
For which schedules are you available?
Job-Related Skills:
Note: Do not fill out any portion of this section you believe to be non-job related.
If the job requires, do you have a valid driver's license?
Have you any moving violations within the last 7 years?
Have you been given a job description or had the essential functions of a job explained to you?
Do you understand these essential functions?
Can you perform the essential functions of this job with or without reasonable accommodation?
Security:
List States and countries of residence for the past seven years: (one per line)
Have you used any names or Social Security numbers other than given above? If so, please comment below.
If yes, comment:
Have you been convicted of a crime in the past 7 years? If so, please describe in the box below. (Conviction will not necessarily be a bar to employment. In accordance with company policy and applicable state and federal laws, factors such as age at the time of offence, remoteness of the offence, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)
If yes, describe below:
Previous Employment:
Note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical. FOR EMPLOYERS OUTSIDE THE U.S.A A CURRENT FAX NUMBER IS MANDATORY.
Most Recent Employer:
Are you currently working for this employer?
If yes, may we contact?
Company Name:
Company Address:
Phone:
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Fax:
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Supervisor Name:
Date Started:
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To:
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Job Title:
Duties:
Salary:
Per:
Reason for Leaving:
Second Most Recent Employer:
Are you currently working here?
May we contact?
Business Name:
The Company Address:
Company Phone:
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Fax Phone:
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Your Supervisor Name:
Date You Started:
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Till:
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Your Job Title:
Your Duties:
Your Salary:
$ Per:
Reason you left:
References:
Note: Include only individuals familiar with your work ability. Do not include relatives.
Reference #1 Name:*
Address:*
Years Known/Relationship:*
Reference #2 Name:*
Address:*
Time Known/Relationship:*
Education:
Note: Do not fill out any part of this section you believe to be non-job related.
Please indicate the highest grade completed.
Comments:
Comments:
Certification and Release:
I certify that i have read and understand the applicant note on this form and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions or misrepresentations of facts called for in this application, whether on this document or not, may result in rejection of my application or discharge at any time during my employment. I authorize the company and / or its agents, including consumer reporting bureaus, to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damage whatsoever for issuing this information. I also understand that the use of illegal drugs is prohibited during employment. If company requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment.
Type the letters and numbers below to prove you are human: