Section I Applicant Information:

Full Name 
Address 
City        State      Zip
Number of years at this address 
Daytime Phone #   Evening Phone #

Social Security #    Date of Birth
Drivers license #  State Issued 

Are you legally eligible to work in the U.S. ?      Yes   No

Job Position Applying for
Salary Desired   Desired Starting Date
Have you ever Applied for our company before? Yes   No
When?
Were you referred to our company? Yes   No
If yes, Who referred you to us?

Are you willing to work any shift including nights, and weekends? Yes   No
If "No" Please state any limitations.

 

Section II Applicants Education History:

High School Name 
High School address (if available)
Last Grade attended   Diploma

College Name
College address (if available)
Number of years attended   Degree

Other Training (Vocational, technical, graduate) 
Other Training cont
Other Training cont
Other Training cont

 

Section III Employment History:

List 3 Previous Employers Beginning with the most recent.

Most Recent Employer

Company Name
Address

Phone #
Supervisor Name
Job Duties
Dates of Employment:
Reason for Leaving

 

Employer 2

Company Name
Address

Phone #
Supervisor Name
Job Duties
Dates of Employment:
Reason for Leaving

 

Employer 3:

Company Name
Address

Phone #
Supervisor Name
Job Duties
Dates of Employment:
Reason for Leaving

List any special Skills you might have that pertain to the job you are applying for:

 

Section IV. Emergency Information

List 2 People that should be contacted in case of emergency:

Name
Address
City  State   Zip Code 

Daytime Phone   Evening
Relationship to you

 

Name
Address
City  State   Zip Code 

Daytime Phone   Evening
Relationship to you

I Certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Dicks Automotive Transport to contact former employers and educational organizations regarding my employment and education. I authorize Former employers and educational organizations to fully and freely communicate information regarding my previous employment attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created. I understand that unless I am offered a specific written contract of employment signed on behalf of thee organization by it's Owners/Partners, the employment relationship will be entirely voluntary in nature. In other words, with appropriate notice, I will have full and complete discretion to end the employment relationship when I chose and for reasons of my choice. Similarly, my employer would have the same right. Moreover, no agent, representative, or employee of Dick's Automotive Transport, except in a specific written contract of employment signed on behalf or the organization by its Owners/Partners, has the power to alter or vary the voluntary nature of the employment relationship.

 

Signed 

Date