Employment Application – Pacific Autow Center

An Equal Opportunity Employer

We are an equal employment opportunity employer and do not discriminate in hiring or employment upon any basis prohibited by law, including race, color, creed, religion, age, sex, national origin, ancestry, sexual orientation, marital status, military status, medical condition, gender identity, or disability. None of the questions or information sought in the application is intended to discriminate based upon any status protected by law.

Name*

First Middle Last

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address (If different)

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Cell Phone*

Employment Desired

Type of Work Applying for*

Full Time
Part Time
Others

What Days & Hours are You Available for Work

Position Applying for*

Days*

Select All
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Hours From*

: HH

MM

To*

: HH

MM

Are you able to work overtime if needed?*

Yes
No

Salary Desired? ($)*

On what date can you start work?*

Personal Information

Are you currently on lay-off or subject to recall?*

Yes
No

Have you ever applied to or worked for the Company before?*

Yes
No

Do you have any friends or relatives working for the Company?*

Yes
No

Do you have any friends or relatives working for the Company?

Name

Relationship

How did you hear about this position?*

If hired, would you have a reliable means of transportation to and from work?*

Yes
No

Are you willing to travel?*

Yes
No

What percentage?

Any restrictions to travel?*

No
Local
OverNight

Are you at least 18 years old?*

Yes
No

Do you have the legal right to work and be employed in The United States?*

Yes
No

(Proof of identity and legal authority to work in the U.S. is conditions of employment.)

Do you have a clear understanding of the job duties for this position?*

Yes
No

Are you able to perform the essential functions of this position, either with or without reasonable accommodation?*

Yes
No

If no, describe the functions that cannot be performed*

EDUCATION, TRAINING AND EXPERIENCE

High School Name*

Name City State / Province / Region No. of Years Completed

Did you Graduate?*

Yes
No

Degree/ Diploma Received*

College/ University*

Name City State / Province / Region No. of Years Completed

Did you Graduate?*

Yes
No

Degree/ Diploma Received*

Vocational or Business*

Name City State / Province / Region No. of Years Completed

Did you Graduate?*

Yes
No

Degree/ Diploma Received*

List any other education, specialized training/skills, or certificates/licenses you possess relating to this job.

Are you fluent (speak, read, write) in any languages other than English?*

Yes
No

If yes, which language(s)?

EMPLOYMENT HISTORY

Provide details on your last 10 years of employment and/or last 3 employers (whichever is longer) starting with the most recent employer. Note: Attach additional page(s) if necessary. You must complete this section even if attaching a resume.

Name of Employer	Telephone Number	Position Held	Supervisor’s Name

Street Address City State / Province / Region ZIP / Postal Code

Date Employed From

MM

DD

YYYY

To

MM

DD

YYYY

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Name of Employer	Telephone Number	Position Held	Supervisor’s Name

Street Address City State / Province / Region ZIP / Postal Code

Date Employed From

MM

DD

YYYY

To

MM

DD

YYYY

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Name of Employer	Telephone Number	Position Held	Supervisor’s Name

Street Address City State / Province / Region ZIP / Postal Code

Date Employed From

MM

DD

YYYY

To

MM

DD

YYYY

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Name of Employer	Telephone Number	Position Held	Supervisor’s Name

Street Address City State / Province / Region ZIP / Postal Code

Date Employed From

MM

DD

YYYY

To

MM

DD

YYYY

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Please identify and explain all periods of unemployment during the last 10 years:

From	To	Reason for Unemployment

REFERENCES

List below three persons not related to you who have knowledge of your work performance within the last three years.

Name	Telephone

Address

Street Address City State / Province / Region ZIP / Postal Code

Business Name

Occupation

No. of Years Acquainted

Name	Telephone

Address

Street Address City State / Province / Region ZIP / Postal Code

Business Name

Occupation

No. of Years Acquainted

Please read carefully. Initial each paragraph and sign below. Your agreement to the terms below is a condition for consideration of employment with The Company.

I hereby certify that the answers given by me on this application are true and correct to the best of my knowledge, and that I have not knowingly withheld any information that might adversely affect my chances for employment. I understand that any misstatement or omission of fact on this application or any documents used to obtain employment may result in rejection of this application or immediate discharge if I am employed; regardless of the time elapsed before discovery of the misstatement or omission. I further certify that I, the applicant, have personally completed this application.
Background Check. I hereby authorize the Company to investigate my references, prior employers, work record, education and other matters related to my suitability for employment and further, authorize the references I have listed, all prior employers, and all educational institutions attended, to disclose to the Company any and all letters, reports and other information related to my records, including but not limited to my performance reviews and evaluations, discipline, commendations, awards, and all other employment information, without giving me prior notice of such disclosure. By providing this page of the application to the references, prior employers and educational institutions attended, I release them, to the fullest extent permitted by law, from any and all claims, demands, fees and liabilities for providing The Company with all information, and I release the Company and their agents, employees, clients, or representatives, to the fullest extent permitted by law, from any and all claims, demands, fees and liabilities that may result from any use or disclosure of such information by The Company, or any of their agents, employees, clients, or representatives. I authorize The Company to request and obtain a Consumer Report and/or Investigative Consumer Report, which may include, but is not limited to, criminal, credit and driver’s license, provided state law permits and where such inquiries are job related. (Please refer to and complete the Disclosure and Authorization to Obtain Information form).
At Will Employment. I understand that any employment with The Company is at the mutual consent of The Company and me. Accordingly, either The Company or I may terminate my employment at any time, with or without cause, and with or without notice. I understand that except for The Company’s Executive Director, no employee, representative or agent of The Company has authority to modify the at-will nature of my employment. Any modification of the at-will nature of my employment, or any employment agreement for a specified period of time with The Company must be set forth in a written agreement signed and dated by The Company s Executive Director and me. Moreover, nothing conveyed to me, either during any pre-employment interview, or during my employment, if hired, is intended to create an employment contract between The Company and me or to alter the at-will nature of my employment with The Company. In addition, I understand that if hired by The Company this statement shall constitute a final and fully binding integrated agreement with respect to the at-will nature of my employment relationship and that there are no oral or written agreements of any kind contrary to the foregoing.
General. I further understand and agree that as a condition to being employed by The Company, I will be required to agree to conduct myself in accordance with The Company’s personnel practices and policies as set forth in the Employee Handbook, a copy of which I will be provided and will review in accepting employment with The Company.

Applicant’s Signature

Date

Printed Name