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OFFICE FORMS

Made in U.S.A.

Employee File Jacket Keep track of your employee’s important data all in one convenient location. Front of jacket includes sections for employee personal data, as well as space for emergency information and employment history. Back of jacket has space for termination information and additional notes. • 9” x 12” • Prints in Black ink on high quality 32# Buff jacket • Packaged 50 per pack • Quantity price breaks are: 1, 3, 5, 10, 20 packs

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Back

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#821 ( Form #201)

Made in U.S.A.

Application for Employment

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This form has been designed to strictly comply with State and Federal Fair Employment Practice Laws prohibiting employment discrimination. This form contains 4 pages and is folded at a convenient 8-1/2" x 11" for easy filing. • Folded to 8-1/2” x 11” • 1-part cut sheet • 60# White offset paper • Prints in Black ink • Packaged 50 per pack • Quantity price breaks are: 1, 3, 5, 10, 20 packs

APPLICATION FOR EMPLOYMENT

PRE-EMPLOYMENTQUESTIONNAIRE -EQUALOPPORTUNITYEMPLOYER

Date_________________

PositionDesired

SalaryDesired

AvailableDate

FullTime

PartTime

AREANEQUALOPPORTUNITYEMPLOYER APPLICANT’SSTATEMENT

righttoterminatemyemploymentatanytimewithorwithoutnotice,andtheCompanyhasthesameright. NooneotherthanthePresidentofthe

writing.

IunderstandthattheCompanyreservestherighttorequiremetosubmittomedicalexaminationsanddrug/alcoholtests,priortoandduring employment,aspermittedbylaw. IalsounderstandthatImayberequiredtotakeothertests,suchaspersonalityandhonestytests,priortoand duringmy employment, as permittedby law. IauthorizetheCompanytoinvestigatemybackground,character,reputation,personalcharacteristics,drivingrecord,employmenthistory,and criminalrecord,includingobtaininginvestigativereports,aspermittedbylaw.Iexpresslyauthorizeallindividualswithsuchknowledgetorelease informationtotheCompany,includingbutnotlimitedtoreferencesI’velistedherein,myprioremployers,andallindividualsassociatedwiththem. Iherebyfullywaiveanyandallclaimsarisingdirectlyorindirectlyfromsuchdisclosuresandtheiruse,whetherthedisclosuresarefavorableor unfavorable tome. IherebystatethatalltheinformationthatIhaveprovidedonthisapplication,andallinformationIwillprovideintheapplication,interviewand hiring processwillbe trueandaccurate. If Iam employed andany such information is later found tobe false inany respect, Imaybe dismissed.

Designed specifically for the Automotive Industry

DONOTSIGNUNTILYOUHAVEREADTHEABOVESTATEMENT

______________________________________________ SignatureofApplicant

PERSONALDATA (PleasePrint)

LASTNAME FIRSTNAME MIDDLE INITIAL

SOCIALSECURITYNUMBER

HOMETELEPHONENUMBER

PRESENTADDRESS

CELLPHONENUMBER

CITY STATE ZIP

HOWLONGATTHISADDRESS?

PREVIOUSADDRESS

CITY STATE ZIP

HOW LONGATTHISADDRESS?

E-MAIL

WHOREFERREDYOUTOTHISCOMPANY? EMPLOYMENTAGENCY NEWSPAPER

OTHER (DESCRIBE) ________________

FRIEND

EMPLOYEE

STATEEMPLOYMENTAGENCY

WALK IN

INTERNET

Are you 18 yearsofage or older? Yes No

Have you everworked for thisCompany before? Yes No If yes,please givedatesand position: ________________________________

Do youhaveany friendsor relativesworkinghere? Yes No If yes, Name:__________________Relationship:___________________

Do you have ameansof transportation thatwillallow you to consistently arrive atworkon time? Yes No

Ifa driver’s license is required for theSPECIFICposition for ______________________________________________________ which youareapplying, do you have a validdriver’s license? Yes No LicenseNo. State Issued Exp.Date

years? Yes No If yes,pleasegivedate anddetails: _________________________________________________________________________________________________________________________ Have you everpled guiltyor “no contest” toa crimeorbeen convictedofa crime? Note:Answering “yes” to thisquestion doesnot constitute an automaticbar toemployment. Yes No If yes,give date and detailsof each: ___________________________________________________________________________________________________________________________ NOTE: A separate FCRA formmust be executed to obtain investigative reports from third parties about an applicant. Some states prohibit questions about criminal history, such as thosewhich have been expunged. Consult the rules of the states inwhich you operateprior to asking questionsaboutan applicant’s criminalhistory.

RECORDOFPREVIOUSEMPLOYMENT

CHARACTERREFERENCES Please listpersonswho know youwell -Notpreviousemployers or relatives

EDUCATION

Besure

HighSchool

College /University

Graduate /Professional

to account for all periods of time name and supply business references. Name ofPresent orLastEmployer

Address (Street,CityandState)

Name

Occupation

PhoneNumber YearsKnown

SchoolName

Employment

YourTitleorPosition

Reason forLeaving

From (Mo./Yr.) To (Mo./Yr.)

Years completed: (Circle)

9 10 11 12 1 2 3 4 1 2 3 4

Address

Diploma /Degree Describe course of study ormajor

ToReorder: Specify Item #820FormEMP-1 Revised (10/11)

City,State,ZipCode

Pay

Name of LastSupervisor

Start

Final

Telephone ( )

$

$

DescribeSpecialized Training,Military Experience,Special

Name ofPresent orLastEmployer

Employment

YourTitleorPosition

Reason forLeaving

From (Mo./Yr.) To (Mo./Yr.)

Address

Page 1 contains all personal data and applicant’s statement. #820 ( Form #EMP-1)

and/orSkillspertaining to the position forwhich you are applying

ADDITIONAL INFORMATION - Please indicateany actualexperiencesyouhave in anyof the followingpositions: OFFICE SALES /LEASING SERVICE&REPAIR PARTS SalesManager ServiceManager PartsManager Bookkeeper SalesPerson (NewCar) ServiceWriter/Advisor PartsCounter AccountsReceivable SalesPerson (UsedCar) Dispatcher PartsStocker AccountsPayable SalesPerson (Truck) ShopForeman PartsDriver PayrollClerk F& IManager Mechanic/Technician Other Tag/TitleClerk LeasingManager Electrician OTHER WarrantyClerk FleetManager Helper Machinist DataEntry TruckManager Painter Porter / Janitor Cashier UsedCarManager BodyRepair Security Receptionist Rentals GetReady Driver /Messenger Other Other Other Maintenance DONOTWRITE INTHISSPACE -FOR INTERVIEWER’SUSEONLY Interviewed by: Department: Date: Comments:

City,State,ZipCode

Pay

Name of LastSupervisor

Start

Final

Telephone ( )

$

$

Employment

Name ofPresent orLastEmployer

(Foradditional informationuse separate sheet)

YourTitleorPosition

Reason forLeaving

From (Mo./Yr.) To (Mo./Yr.)

Address

GENERAL INFORMATION Can you provide documentation that you have the right towork in theUnitedStates? Yes No _________ (Your Initials) _____________________________________________________________________________________________________________ Can you type (if applicable to the job you seek)? Yes No If yes, please provide your average speed: _________________words perminute. Are youavailable toworkweekends and evenings if necessary? Yes No Are you capableofperforming theessential job functionsof theposition forwhich youareapplying,withorwithout reasonable accommodationofanydisability? Yes No Can youmeet theSPECIFIC attendance requirements of the job forwhich youare applying? Yes No Do you currently use illegal drugs? Yes No Have you ever been convicted for the use, sale, or possession of illegal drugs? Yes No Note:Some states prevent questions aboutmarijuana convictions andminor drug related offenses. Have you submitted any lettersof recommendation youmay have from previous employers? Yes No Additional comments concerningabove information: ___________________________________________________________________ Did you have any unauthorized absences from your last job? Yes No

City,State,ZipCode

Pay

Name of LastSupervisor

Start

Final

Telephone ( )

$

$

Name ofPresent orLastEmployer

Employment

Reason forLeaving

YourTitleorPosition

From (Mo./Yr.) To (Mo./Yr.)

Address

City,State,ZipCode

Pay

Name of LastSupervisor

Start

Final

Telephone ( )

$

$

Name ofPresent orLastEmployer

Employment

Reason forLeaving

YourTitleorPosition

From (Mo./Yr.) To (Mo./Yr.)

Address

City,State,ZipCode

Pay

Name of LastSupervisor

Start

Final

Telephone ( )

$

$

Have you ever been involuntarily terminated or asked to resign from any job? Yes No If yes, please explain the circumstances:

_______________________________________________________________________________________________________________

DATEHIRED

FORPOSITION

FORDEPARTMENT

STARTINGWAGES

SUPERVISORTOREPORTTO:

_______________________________________________________________________________________________________________

PER

Page 4 contains character references and previous automotive experience. THISAPPLICATIONWILLBECONSIDEREDACTIVEFORAMAXIMUMOFTHIRTY (30)DAYS. IFYOUWISHTOBE CONSIDEREDFOREMPLOYMENTAFTERTHATTIME,YOUMUSTREAPPLY. Iunderstand and agree that asa conditionofemployment, Imay be required to successfully completea drug and/oralcohol screening test beforebecoming an employee. In addition, the company reserves the right toadminister a drugand/or alcohol screening test, to themaximum extent permittedby law, to anyand/orall employees at any time during theiremployment forany (or no) reason. ICERTIFYTHATALLOFTHE INFORMATIONTHAT IHAVEPROVIDEDONTHISAPPLICATION ISTRUEANDACCURATE. _______________________________ ______________________________________________________________________ Date SignatureofApplicant ATTENTIONUSER: It is the user’s responsibility to ensure that this form and its use complieswith applicable laws,which change from time to time. Seller assumes no responsibility and hereby disclaims any liability for the inclusion in this form of any questions or requests for information uponwhich a violation of local, state and/or federal lawmay be based. The interviewer should be knowledgeable of current laws andbe careful not todiscriminate in anyway.

_______________________________________________________________________________________________________________

Please explain fullyany gaps in your employmenthistory:

EMERGENCY INFORMATION

In case of an accident or other emergency,who shouldwe contact? Name: __________________________________________________________ Relationship: ___________________________________ HomeAddress ________________________________________________________________ Telephone ________________________ Street City State WorkAddress ________________________________________________________________ Telephone ________________________ Street City State

Maywe contact your current employer? Yes No If no,please explain:

Page 2 contains education and general information such as emergency contact information.

Page 3 contains detailed information regarding previous employment.

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