Personal Information * Required Fields
* First Name:
* Last Name:
* Your E-mail:
* Address:
* Years At This Address:
* City:
* Phone Number:
Cell Number: (optional)
* Referred By:
None Walk In TV Radio Newspaper Friend LeisureMax Website Internet Search Engine Temp Service Other
* Contact Type:
Email Phone Cell
* 18 Years Or Older:
Yes No
* Desired Employment
Driver Telephone Reservation Specialist Ride Attendand
* Date You Can Start:
* Salary Desired:
* Are You Employed Now ?
Yes No
Education
Grammar School: Name & Location Of School
Years Attended:
High School: Name & Location Of School
Years Attended:
College: Name & Location Of School
Years Attended:
Trade, Business, Other School: Name & Location Of School
Years Attended:
Former Employers
1. Name & Address of Present Employer:
Phone Number:
May we contact them:
Yes No
Starting Date:
End Date:
Reason for leaving:
2. Name & Address of Past Employer:
Phone Number:
May we contact them:
Yes No
Starting Date:
End Date:
Reason for leaving:
References
* Reference 1
* Reference 2
* Reference 3
Service Record
Military:Branch of Service and Discharge Date:
Please list any Special Skills that would be an asset to our company:
* Have you ever been convicted of a Felony within the last 5 Years ?
Yes No
If "Yes" Please Explain ( Will not necessarily exclude you from consideration )
* Do you have any medical conditions that may inhibit your performing certain duties ? (i.e.: lifting, standing,etc.)
Yes No
If "Yes" Please Explain ( Will not necessarily exclude you from consideration )
Additional Information ( Optional )
If you would like to include any additional information you may do so here.
APPLICANT'S STATEMENT
AUTHORIZATION "I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employees listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise and release the company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by authorized company representative."
